Provider Demographics
NPI:1275699761
Name:PHILLIPS, WENDY ELLEN (PHD, PT)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ELLEN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 CLAIRE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1828
Mailing Address - Country:US
Mailing Address - Phone:404-798-1961
Mailing Address - Fax:494-377-9799
Practice Address - Street 1:444 CLAIRE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1828
Practice Address - Country:US
Practice Address - Phone:404-798-1961
Practice Address - Fax:494-377-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist