Provider Demographics
NPI:1912409178
Name:SHIPPEY, RAYMUND PEARCE (MS, PT, MBA)
Entity Type:Individual
Prefix:
First Name:RAYMUND
Middle Name:PEARCE
Last Name:SHIPPEY
Suffix:
Gender:M
Credentials:MS, PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 W MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1600
Mailing Address - Country:US
Mailing Address - Phone:616-523-1010
Mailing Address - Fax:
Practice Address - Street 1:537 W MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1600
Practice Address - Country:US
Practice Address - Phone:616-523-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist