Provider Demographics
NPI:1205878865
Name:BLAYNE ROBINSON LIPAROTO
Entity type:Organization
Organization Name:BLAYNE ROBINSON LIPAROTO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIPAROTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-654-8127
Mailing Address - Street 1:4572 TELEPHONE RD
Mailing Address - Street 2:SUITE 903
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5662
Mailing Address - Country:US
Mailing Address - Phone:805-654-8127
Mailing Address - Fax:
Practice Address - Street 1:4572 TELEPHONE RD
Practice Address - Street 2:SUITE 903
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5662
Practice Address - Country:US
Practice Address - Phone:805-654-8127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14545261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15028Medicare ID - Type Unspecified
CAW15028Medicare UPIN