Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT1688 | TN |
NPI | 1003016213 |
---|---|
Provider Name | Ms. Penny Carolyn Tipps |
First Address | Tullahoma, TN 37388-8259 |
Second Address | Tullahoma, TN 37388-8259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 25/07/2007 |