Provider Demographics
NPI:1902065048
Name:TIPPING, KATHRYN PAINTER (PTA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:PAINTER
Last Name:TIPPING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:PAINTER
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1701 S TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2999
Mailing Address - Country:US
Mailing Address - Phone:702-871-0005
Mailing Address - Fax:
Practice Address - Street 1:1701 S TORREY PINES DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2999
Practice Address - Country:US
Practice Address - Phone:702-871-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA 0227225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant