Provider Demographics
NPI:1932488236
Name:NIPPER, JOSHUA A (ATP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:NIPPER
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 SHILOH RD STE 158B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-1596
Mailing Address - Country:US
Mailing Address - Phone:214-319-7772
Mailing Address - Fax:214-319-9411
Practice Address - Street 1:12015 SHILOH RD STE 158B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-1596
Practice Address - Country:US
Practice Address - Phone:214-319-7772
Practice Address - Fax:214-319-9411
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILATP47600225CA2500X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier