Provider Demographics
NPI:1235963737
Name:PIPPIN, BENJAMIN A (LMT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:A
Last Name:PIPPIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 WIMBLEDON DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-3113
Mailing Address - Country:US
Mailing Address - Phone:334-405-0706
Mailing Address - Fax:
Practice Address - Street 1:3246 MONTGOMERY HWY STE 207
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2103
Practice Address - Country:US
Practice Address - Phone:334-791-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA105456225700000X
AL4329225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist