Provider Demographics
NPI:1255844346
Name:PHILLIPS, JAMES BRIAN (LMT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRIAN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3561
Mailing Address - Country:US
Mailing Address - Phone:501-286-3982
Mailing Address - Fax:
Practice Address - Street 1:1000 TURNBERRY DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3561
Practice Address - Country:US
Practice Address - Phone:501-286-3982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty