Provider Demographics
NPI:1033458286
Name:PHAKLIDES, TRISHA LYNNE (LAC)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:LYNNE
Last Name:PHAKLIDES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2225 E MURRAY HOLLADAY RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5382
Mailing Address - Country:US
Mailing Address - Phone:801-272-1522
Mailing Address - Fax:
Practice Address - Street 1:2225 E MURRAY HOLLADAY RD
Practice Address - Street 2:SUITE 108
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5382
Practice Address - Country:US
Practice Address - Phone:801-272-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7929741-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist