Provider Demographics
NPI:1811954803
Name:TIPTON PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:TIPTON PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-775-9999
Mailing Address - Street 1:8400 E FLORENTINE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8653
Mailing Address - Country:US
Mailing Address - Phone:928-775-9999
Mailing Address - Fax:928-775-9998
Practice Address - Street 1:8400 E FLORENTINE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8653
Practice Address - Country:US
Practice Address - Phone:928-775-9999
Practice Address - Fax:928-775-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2018-09-10
Deactivation Date:2006-07-17
Deactivation Code:
Reactivation Date:2006-08-30
Provider Licenses
StateLicense IDTaxonomies
AZ5049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115AZ60188OtherTRIWEST DCN
AZ3Z2680OtherHEALTHNET
AZ670847OtherUNITED HEALTHCARE
AZ707440OtherWELLCARE
AZ191587Medicaid
AZ106263700OtherDEPT OF LABOR
AZ106263700OtherDEPT OF LABOR
AZ707440OtherWELLCARE
Z72692Medicare ID - Type Unspecified