MEDICARE: ASHLEY PHILLIPS PT, DPT

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
1	225100000X	Physical Therapist	070.024162	IL

General Provider Information

NPI Number	:	1164988184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY PHILLIPS PT, DPT

Provider Business Mailing Address
First Line	:	849 S ROUTE 51 STE D
Second Line	:
City	:	FORSYTH
State	:	IL
Zip	:	62535-8807
Country	:	US
Telephone Number	:	217-872-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	849 S ROUTE 51 STE D
Second Line	:
City	:	FORSYTH
State	:	IL
Zip	:	62535-8807
Country	:	US
Telephone Number	:	217-872-2244
Fax Number	:	866-394-6713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	02/14/2019

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Directions to “ ASHLEY PHILLIPS PT, DPT” Practice Location

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