Provider Demographics
NPI:1720203649
Name:PHILLIPS, CAMILLE T (PT)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:T
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 CORTEZ RD W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3106
Mailing Address - Country:US
Mailing Address - Phone:941-739-7828
Mailing Address - Fax:941-739-7838
Practice Address - Street 1:3637 CORTEZ RD W
Practice Address - Street 2:SUITE 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3106
Practice Address - Country:US
Practice Address - Phone:941-739-7828
Practice Address - Fax:941-739-7838
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist