Provider Demographics
NPI:1619007747
Name:PHILLIPS, CHRIS (PT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4401
Mailing Address - Country:US
Mailing Address - Phone:432-570-8782
Mailing Address - Fax:432-683-8476
Practice Address - Street 1:4519 N GARFIELD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3415
Practice Address - Country:US
Practice Address - Phone:432-570-8782
Practice Address - Fax:432-683-8476
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-6646Medicare ID - Type Unspecified