Provider Demographics
NPI:1518297639
Name:PHILLIPS, CASEY MICHELLE (ATC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MICHELLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 W OMAHA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-4805
Mailing Address - Country:US
Mailing Address - Phone:559-593-2456
Mailing Address - Fax:
Practice Address - Street 1:592 W OMAHA AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-4805
Practice Address - Country:US
Practice Address - Phone:559-593-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor