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NPI Code Detail

MEDICARE: TAMIKO DT PHILLIPS

MEDICARE: TAMIKO DT PHILLIPS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1033403670
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMIKO DT PHILLIPS
Provider Business Mailing Address
First Line : 7421 LONGHORN LODGE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4008
Country : US
Telephone Number : 702-597-9505
Fax Number :
Provider Business Practice Location Address
First Line : 2775 S JONES BLVD STE 101
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-5632
Country : US
Telephone Number : 702-685-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2011
Last Update Date : 05/31/2011

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Directions to “ TAMIKO DT PHILLIPS ” Practice Location

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