Individual
JUDAH L PHIPPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
407 E MARKET ST STE 102, CRAWFORDSVILLE, IN 47933-1852
(765) 362-1500
Mailing address
7879 S 700 W, WILLIAMSPORT, IN 47993-8264
(765) 426-3768
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005552A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06005552A
STATE LICENSE
IN
Enumeration date
05/08/2020
Last updated
05/08/2020
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