Provider Demographics
NPI:1356493480
Name:PHILLIPS, SARA D (LMP,CMT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMP,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 E 38TH CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4406
Mailing Address - Country:US
Mailing Address - Phone:907-952-8613
Mailing Address - Fax:
Practice Address - Street 1:6030 E 38TH CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4406
Practice Address - Country:US
Practice Address - Phone:907-952-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018328174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist