Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033403670 |
---|---|
Provider Name | Tamiko Dt Phillips |
First Address | Las Vegas, NV 89113-4008 |
Second Address | Las Vegas, NV 89146-5632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 31/05/2011 |