Provider Demographics
NPI:1952702524
Name:PHILLIPS, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:430 E FLOATING FEATHER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4005
Mailing Address - Country:US
Mailing Address - Phone:208-992-7550
Mailing Address - Fax:208-556-7830
Practice Address - Street 1:430 E FLOATING FEATHER RD
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4005
Practice Address - Country:US
Practice Address - Phone:208-992-7550
Practice Address - Fax:208-556-7830
Is Sole Proprietor?:No
Enumeration Date:2014-09-14
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3736225100000X
ID3656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist