Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 08020R | LA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 08020R | LA |
NPI | 1104345206 |
---|---|
Provider Name | Jeffrey M Phillips |
First Address | Shreveport, LA 71105-5694 |
Second Address | Bossier City, LA 71111-5851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2017 |
Last Update Date | 17/03/2018 |