Provider Demographics
NPI:1255093811
Name:PHIPPS, KEELEY (ATC)
Entity Type:Individual
Prefix:
First Name:KEELEY
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 E MAGNESIUM RD APT 248
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-7302
Mailing Address - Country:US
Mailing Address - Phone:509-430-8832
Mailing Address - Fax:
Practice Address - Street 1:707 S PARK ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-7025
Practice Address - Country:US
Practice Address - Phone:509-276-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer