Provider Demographics
NPI:1538226071
Name:ZIPPLE, JOHN T (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:ZIPPLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HEALTH PROFESSIONS BLD
Mailing Address - Street 2:CENTRAL MICHIGAN UNIVERSITY
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48859-0001
Mailing Address - Country:US
Mailing Address - Phone:989-774-3904
Mailing Address - Fax:989-774-1891
Practice Address - Street 1:1101 HEALTH PROFESSIONS BLD
Practice Address - Street 2:CENTRAL MICHIGAN UNIVERSITY
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-0001
Practice Address - Country:US
Practice Address - Phone:989-774-3904
Practice Address - Fax:989-774-1891
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501300646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C71103OtherBCBSM
MI352191234OtherPPOM PROVIDER NUMBER
MI352191234OtherPPOM PROVIDER NUMBER
MI0N63410002Medicare ID - Type UnspecifiedPROVIDER GROUP NUMBER