Provider Demographics
NPI:1437503315
Name:HILL, PHILLIP BRADLEY (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:BRADLEY
Last Name:HILL
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4060
Mailing Address - Country:US
Mailing Address - Phone:318-323-2237
Mailing Address - Fax:318-324-0316
Practice Address - Street 1:600 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4060
Practice Address - Country:US
Practice Address - Phone:318-323-2237
Practice Address - Fax:318-324-0316
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.200049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist