Provider Demographics
NPI:1205007580
Name:RAAGAS, PHYLLIS JARAMILLA (PT)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:JARAMILLA
Last Name:RAAGAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W 5TH ST
Mailing Address - Street 2:SUITE D & E
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2501
Mailing Address - Country:US
Mailing Address - Phone:717-728-6965
Mailing Address - Fax:
Practice Address - Street 1:214 W 5TH ST
Practice Address - Street 2:SUITE D & E
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2501
Practice Address - Country:US
Practice Address - Phone:717-728-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006009286225100000X
PAPT018439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist