Provider Demographics
NPI:1184148405
Name:PHILLIPS, CARL E II (CRT)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:PHILLIPS
Suffix:II
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 DISTRIBUTION AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2742
Mailing Address - Country:US
Mailing Address - Phone:904-387-4481
Mailing Address - Fax:904-389-6965
Practice Address - Street 1:6851 DISTRIBUTION AVE.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-387-4481
Practice Address - Fax:904-389-6965
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT14479227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified