Provider Demographics
NPI:1992286199
Name:SIPPLE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SIPPLE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:814-881-7181
Mailing Address - Street 1:2551 N GREEN VALLEY PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2111
Mailing Address - Country:US
Mailing Address - Phone:702-476-9759
Mailing Address - Fax:702-665-4096
Practice Address - Street 1:2551 N GREEN VALLEY PKWY STE 205B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0272
Practice Address - Country:US
Practice Address - Phone:702-476-9759
Practice Address - Fax:702-665-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy