Provider Demographics
NPI:1770872673
Name:PHILLIPS, WENDY JILL (PT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:JILL
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 GLENNWOOD AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-0000
Mailing Address - Country:US
Mailing Address - Phone:919-781-9565
Mailing Address - Fax:919-781-9564
Practice Address - Street 1:2626 GLENNWOOD AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-0000
Practice Address - Country:US
Practice Address - Phone:919-781-9565
Practice Address - Fax:919-781-9564
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist