Provider Demographics
NPI:1669060141
Name:PHILLIPS, NATHANIEL ALEC (LMT)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:ALEC
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:ALEC
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1800 W ELLIOT RD UNIT 128
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8820
Mailing Address - Country:US
Mailing Address - Phone:480-246-0982
Mailing Address - Fax:
Practice Address - Street 1:1800 W ELLIOT RD UNIT 128
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8820
Practice Address - Country:US
Practice Address - Phone:480-246-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-19713225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist