Provider Demographics
NPI:1528094935
Name:PIPKIN, DIANE (MPT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:PIPKIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4744 NW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1083
Mailing Address - Country:US
Mailing Address - Phone:352-328-8021
Mailing Address - Fax:
Practice Address - Street 1:108 NW 76TH DR
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6652
Practice Address - Country:US
Practice Address - Phone:352-331-3161
Practice Address - Fax:352-331-3162
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist