Provider Demographics
NPI:1588854020
Name:PHILLIPS, DARLA KIM (PT, DPT, OCS, ATC)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:KIM
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT, DPT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SW 1ST AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5900
Mailing Address - Country:US
Mailing Address - Phone:503-222-1955
Mailing Address - Fax:503-222-1485
Practice Address - Street 1:1500 SW 1ST AVE STE 150
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5900
Practice Address - Country:US
Practice Address - Phone:503-222-1955
Practice Address - Fax:503-222-1485
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33847225100000X
OR6145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist