Provider Demographics
NPI:1306104781
Name:LIPE, JANA (PT)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:LIPE
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 1:8711 VILLAGE DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5418
Mailing Address - Country:US
Mailing Address - Phone:210-297-2725
Mailing Address - Fax:210-297-0215
Practice Address - Street 1:8711 VILLAGE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5418
Practice Address - Country:US
Practice Address - Phone:210-297-2725
Practice Address - Fax:210-297-0215
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist