Provider Demographics
NPI:1841565231
Name:RAK, PHYLLIS AMANDA
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:AMANDA
Last Name:RAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18236 SILVERLEAF CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89508-5047
Mailing Address - Country:US
Mailing Address - Phone:352-538-2143
Mailing Address - Fax:
Practice Address - Street 1:18236 SILVERLEAF CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89508
Practice Address - Country:US
Practice Address - Phone:775-324-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner