Provider Demographics
NPI:1215016696
Name:PHILLIPS, ERIK RYAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:RYAN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5647 CABOT COVE DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9024
Mailing Address - Country:US
Mailing Address - Phone:304-481-8792
Mailing Address - Fax:
Practice Address - Street 1:3983 JACKPOT RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8637
Practice Address - Country:US
Practice Address - Phone:614-539-5301
Practice Address - Fax:614-539-8658
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11601225100000X
WV2535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist