Provider Demographics
NPI:1972652527
Name:PHILLIPS, DINA DENISE
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:DENISE
Last Name:PHILLIPS
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 1:4642 N LOOP 289 STE 105
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-2422
Mailing Address - Country:US
Mailing Address - Phone:806-771-3030
Mailing Address - Fax:
Practice Address - Street 1:4642 N LOOP 289 STE 105
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2422
Practice Address - Country:US
Practice Address - Phone:806-771-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXOT003218225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand