Provider Demographics
NPI:1205805041
Name:VOORHIS, PHILLIP EDWARD (ATC, MSED)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:EDWARD
Last Name:VOORHIS
Suffix:
Gender:M
Credentials:ATC, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 VIENNA BLVD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2651
Mailing Address - Country:US
Mailing Address - Phone:815-753-0211
Mailing Address - Fax:815-753-1874
Practice Address - Street 1:NORTHERN ILLINOIS UNIVERSITY-HUSKIE STADIUM
Practice Address - Street 2:1245 STADIUM DRIVE SOUTH
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2854
Practice Address - Country:US
Practice Address - Phone:815-753-0211
Practice Address - Fax:815-753-1874
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960003442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer