Provider Demographics
NPI:1538922380
Name:LIPFORD, AMY BROOKE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:BROOKE
Last Name:LIPFORD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3453 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-8908
Mailing Address - Country:US
Mailing Address - Phone:850-573-6567
Mailing Address - Fax:
Practice Address - Street 1:4295 5TH AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2176
Practice Address - Country:US
Practice Address - Phone:850-482-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist