Provider Demographics
NPI:1215406988
Name:PRAGER, PHILLIP THOMAS
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:THOMAS
Last Name:PRAGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11652 E BERRY AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4155
Mailing Address - Country:US
Mailing Address - Phone:303-990-1611
Mailing Address - Fax:
Practice Address - Street 1:11698 HURON ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2920
Practice Address - Country:US
Practice Address - Phone:720-381-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician