Provider Demographics
NPI:1902034473
Name:PHILLIPPE, PAULETTE (LMT)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:PHILLIPPE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BUTTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2009
Mailing Address - Country:US
Mailing Address - Phone:631-754-7576
Mailing Address - Fax:631-754-7407
Practice Address - Street 1:175 WOLF HILL RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1340
Practice Address - Country:US
Practice Address - Phone:631-754-7576
Practice Address - Fax:631-754-7407
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008206172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist