Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10447 | AZ |
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1104258441 |
---|---|
Provider Name | Ashley Nicole Phillips |
First Address | Phoenix, AZ 85044-6691 |
Second Address | Phoenix, AZ 85051-9582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2013 |
Last Update Date | 26/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
834089 | (05) | AZ |