Provider Demographics
NPI:1508982448
Name:PHILLIPS, ALICIA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNN
Last Name:PHILLIPS
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 1:3214 NW 47TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6017
Mailing Address - Country:US
Mailing Address - Phone:352-871-6465
Mailing Address - Fax:352-378-1828
Practice Address - Street 1:5024 NW 27TH CT STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6545
Practice Address - Country:US
Practice Address - Phone:352-871-6465
Practice Address - Fax:352-378-1828
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38426225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC3000OtherBLUE CROSS BLUE SHEILD