Provider Demographics
NPI:1164013850
Name:PHILLIPS, ANDREW H (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HIGHWAY 65 N STE 6
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6676
Mailing Address - Country:US
Mailing Address - Phone:501-745-8881
Mailing Address - Fax:501-745-3113
Practice Address - Street 1:230 HIGHWAY 65 N STE 6
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6676
Practice Address - Country:US
Practice Address - Phone:501-745-8881
Practice Address - Fax:501-745-3113
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4608225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant