Provider Demographics
NPI:1649429457
Name:PHILLIPS-ZEE, JAMES GERALD (PTA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GERALD
Last Name:PHILLIPS-ZEE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2240
Mailing Address - Country:US
Mailing Address - Phone:618-457-6658
Mailing Address - Fax:
Practice Address - Street 1:214 S GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2240
Practice Address - Country:US
Practice Address - Phone:618-457-6658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.002394225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant