Provider Demographics
NPI:1194039917
Name:PHILLIPS, ELIZABETH ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N NOVA RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4689
Mailing Address - Country:US
Mailing Address - Phone:386-226-0081
Mailing Address - Fax:386-226-2148
Practice Address - Street 1:821 N NOVA RD
Practice Address - Street 2:SUITE #1
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4689
Practice Address - Country:US
Practice Address - Phone:386-226-0081
Practice Address - Fax:386-226-2148
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA41654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA41654OtherLMT