Provider Demographics
NPI:1932183787
Name:LIPPE, BENJAMIN (MPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:LIPPE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 E INDIANA ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2794
Mailing Address - Country:US
Mailing Address - Phone:812-476-0409
Mailing Address - Fax:812-476-1016
Practice Address - Street 1:533 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1617
Practice Address - Country:US
Practice Address - Phone:812-759-3001
Practice Address - Fax:812-401-9013
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005650A225100000X
KY005391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000280217OtherBLUE CROSS BLUE SHIELD
INP00060081OtherMEDICARE RAILROAD
IN200818630Medicaid
IN000000280217OtherBLUE CROSS BLUE SHIELD