Provider Demographics
NPI:1861538423
Name:IPPOLITO, ERIN NICOLE (MPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:IPPOLITO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:NICOLE
Other - Last Name:AMASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:5840 CORPORATE WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2040
Mailing Address - Country:US
Mailing Address - Phone:561-432-0111
Mailing Address - Fax:561-432-1075
Practice Address - Street 1:6169 S JOG RD STE A11
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6586
Practice Address - Country:US
Practice Address - Phone:561-432-0111
Practice Address - Fax:561-432-1075
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U3120XMedicare ID - Type Unspecified