Provider Demographics
NPI:1598435323
Name:REECE, PHILLIP (PROFSSIONAL)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:REECE
Suffix:
Gender:M
Credentials:PROFSSIONAL
Other - Prefix:MRS
Other - First Name:MEREL
Other - Middle Name:
Other - Last Name:GHANIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ALLAN DO
Mailing Address - Street 1:9001 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3621
Mailing Address - Country:US
Mailing Address - Phone:586-983-8133
Mailing Address - Fax:586-983-8135
Practice Address - Street 1:9001 15 MILE RD STE C
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3621
Practice Address - Country:US
Practice Address - Phone:586-604-1704
Practice Address - Fax:586-983-8135
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
MI7501006805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI85-1437367OtherMESSAGE THERAPIST