Provider Demographics
NPI:1215233218
Name:TIPTON, DONNA (PT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:TIPTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 LEGENDS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3600
Mailing Address - Country:US
Mailing Address - Phone:636-549-3677
Mailing Address - Fax:
Practice Address - Street 1:1525 VILLA DR
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-2586
Practice Address - Country:US
Practice Address - Phone:636-931-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPT102201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist