Provider Demographics
NPI:1861598468
Name:TRIPOD, JON CLIFFORD (PT,)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:CLIFFORD
Last Name:TRIPOD
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 1:1457 GREENE ROAD 607
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72412-8883
Mailing Address - Country:US
Mailing Address - Phone:870-236-9282
Mailing Address - Fax:
Practice Address - Street 1:900 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5942
Practice Address - Country:US
Practice Address - Phone:870-239-7025
Practice Address - Fax:870-239-7288
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1244225100000X
MO104178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist