Provider Demographics
NPI:1295062032
Name:SHIPPER, JEFFREY ERIK (LMT, CPT, RYT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ERIK
Last Name:SHIPPER
Suffix:
Gender:M
Credentials:LMT, CPT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S SUNSET DR
Mailing Address - Street 2:SUITE B1
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5406
Mailing Address - Country:US
Mailing Address - Phone:928-600-2609
Mailing Address - Fax:
Practice Address - Street 1:210 S SUNSET DR
Practice Address - Street 2:SUITE B1
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5406
Practice Address - Country:US
Practice Address - Phone:928-600-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-02903P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist