Provider Demographics
NPI:1780341115
Name:SHIPMAN, SREYSELA RUTH
Entity type:Individual
Prefix:
First Name:SREYSELA
Middle Name:RUTH
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15147 W CORTEZ ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5236
Mailing Address - Country:US
Mailing Address - Phone:623-249-9198
Mailing Address - Fax:
Practice Address - Street 1:10503 W THUNDERBIRD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2746
Practice Address - Country:US
Practice Address - Phone:623-888-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant