Provider Demographics
NPI:1073624979
Name:PHILLIPS, PATRICIA L (LMP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S PUGET DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4418
Mailing Address - Country:US
Mailing Address - Phone:425-277-1123
Mailing Address - Fax:425-277-0445
Practice Address - Street 1:1900 S PUGET DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4418
Practice Address - Country:US
Practice Address - Phone:425-277-1123
Practice Address - Fax:425-277-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005730225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0078234OtherL & I