Provider Demographics
NPI:1568796258
Name:PHILLIPS, PHYLLIS P (MMT, CHT)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:P
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MMT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 YOUNGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3556
Mailing Address - Country:US
Mailing Address - Phone:303-279-6237
Mailing Address - Fax:303-277-9789
Practice Address - Street 1:1895 YOUNGFIELD ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3556
Practice Address - Country:US
Practice Address - Phone:303-279-6237
Practice Address - Fax:303-277-9789
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7178225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist