Basic Information
| Provider Information | |||||||||
| NPI: | 1003016213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIPPS | ||||||||
| FirstName: | PENNY | ||||||||
| MiddleName: | CAROLYN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 N JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | TULLAHOMA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373888259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313937964 | ||||||||
| FaxNumber: | 9314556308 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 N JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | TULLAHOMA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373888259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313937964 | ||||||||
| FaxNumber: | 9314556308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2007 | ||||||||
| LastUpdateDate: | 07/25/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT1688 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.