1790083913 NPI number — MRS. LEANN PIPPEN TROY P.T.

Table of content: MRS. LEANN PIPPEN TROY P.T. (NPI 1790083913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790083913 NPI number — MRS. LEANN PIPPEN TROY P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROY
Provider First Name:
LEANN
Provider Middle Name:
PIPPEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIPPEN
Provider Other First Name:
LEANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790083913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7840 FM 1960 RD E STE 408409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77346-2259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-812-6665
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7840 FM 1960 RD E STE 408409
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77346-2259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-812-6665
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1132504 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1132504 . This is a "13631424" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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