Provider Demographics
NPI:1295008605
Name:PHILLIPS, ROBIN D (LMP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:5210 CORPORATE CENTER CT SE
Practice Address - Street 2:SUITE D
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5952
Practice Address - Country:US
Practice Address - Phone:360-352-7352
Practice Address - Fax:360-352-7680
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60226468225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0290734OtherL & I