Provider Demographics
NPI:1588179295
Name:PHILLIPS, ROBERT L (PTA, LMT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-4162
Mailing Address - Country:US
Mailing Address - Phone:412-610-5639
Mailing Address - Fax:
Practice Address - Street 1:13380 ROUTE 30 STE 5
Practice Address - Street 2:
Practice Address - City:N HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-1125
Practice Address - Country:US
Practice Address - Phone:412-610-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG011700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist