Provider Demographics
NPI:1639611312
Name:PHILLIPS, CHRISTINA DIANA (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DIANA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:503-443-6156
Mailing Address - Fax:502-363-9969
Practice Address - Street 1:9762 NE 119TH WAY
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-823-8119
Practice Address - Fax:425-823-8282
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2018-12-18
Deactivation Date:2017-10-17
Deactivation Code:
Reactivation Date:2018-04-05
Provider Licenses
StateLicense IDTaxonomies
WA60660691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist