Provider Demographics
NPI:1043404213
Name:PHILLIPS, MARC D (MPT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7622 MCLAUGHLIN RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4710
Mailing Address - Country:US
Mailing Address - Phone:719-495-3133
Mailing Address - Fax:
Practice Address - Street 1:12229 VOYAGER PKWY STE 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3790
Practice Address - Country:US
Practice Address - Phone:719-488-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9745225100000X
COPTL.0009745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist