Provider Demographics
NPI:1407629736
Name:PHILLIPS-HORVE, WYNEMA (LMT)
Entity Type:Individual
Prefix:
First Name:WYNEMA
Middle Name:
Last Name:PHILLIPS-HORVE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 POMEROY LN UNIT 25
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2944
Mailing Address - Country:US
Mailing Address - Phone:413-588-2455
Mailing Address - Fax:
Practice Address - Street 1:376 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-9301
Practice Address - Country:US
Practice Address - Phone:413-588-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17886-MT-MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist