Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD61066661 | WA |
NPI | 1053765628 |
---|---|
Provider Name | Alicia Lynn Phillips |
First Address | Minneapolis, MN 55455-0341 |
Second Address | Minneapolis, MN 55455-0341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2016 |
Last Update Date | 02/10/2020 |