Provider Demographics
NPI:1174793210
Name:PHILLIPS, DANIEL J (LMT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2507
Mailing Address - Country:US
Mailing Address - Phone:256-415-9598
Mailing Address - Fax:
Practice Address - Street 1:214 ANA DR
Practice Address - Street 2:SUITE L
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1748
Practice Address - Country:US
Practice Address - Phone:256-766-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1528225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist