Provider Demographics
NPI:1174865299
Name:BIPPERT, MAKENZIE W (PT)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:W
Last Name:BIPPERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12952 BANDERA RD STE 107
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4733
Mailing Address - Country:US
Mailing Address - Phone:830-346-5454
Mailing Address - Fax:830-346-5455
Practice Address - Street 1:408 US HIGHWAY 90 W STE 200
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-4547
Practice Address - Country:US
Practice Address - Phone:830-346-5454
Practice Address - Fax:830-346-5455
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist