Basic Information
Provider Information
NPI: 1932183787
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIPPE
FirstName: BENJAMIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7300 E INDIANA ST
Address2: STE. 102
City: EVANSVILLE
State: IN
PostalCode: 477152794
CountryCode: US
TelephoneNumber: 8124760409
FaxNumber: 8124761016
Practice Location
Address1: 533 W COLUMBIA ST
Address2:  
City: EVANSVILLE
State: IN
PostalCode: 477101617
CountryCode: US
TelephoneNumber: 8127593001
FaxNumber: 8124019013
Other Information
ProviderEnumerationDate: 12/05/2005
LastUpdateDate: 03/16/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X05005650AINY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X005391KYN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
00000028021701INBLUE CROSS BLUE SHIELDOTHER
P0006008101INMEDICARE RAILROADOTHER
20081863005IN MEDICAID


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