Provider Demographics
NPI:1538749346
Name:LIPPERINI RAMIREZ, SHIRA LYNNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:LYNNE
Last Name:LIPPERINI RAMIREZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:LYNNE
Other - Last Name:LIPPERINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:54 STONY PINE RD
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-6546
Mailing Address - Country:US
Mailing Address - Phone:570-854-5644
Mailing Address - Fax:
Practice Address - Street 1:2489 ROUTE 6 STE 6
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-6144
Practice Address - Country:US
Practice Address - Phone:570-390-7900
Practice Address - Fax:570-390-7901
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA015812OtherSTATE LICENSE