Provider Demographics
NPI:1134080310
Name:PIPPINS, PHILLIP LAWFORD (PTA)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:LAWFORD
Last Name:PIPPINS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3746 S BRIDLEWOOD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2652
Mailing Address - Country:US
Mailing Address - Phone:888-531-2204
Mailing Address - Fax:
Practice Address - Street 1:65 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1091
Practice Address - Country:US
Practice Address - Phone:480-317-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-007390225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty