MEDICARE: MISS CASSANDRA GAY PHILLIPS ATC

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	2255A2300X	Athletic Trainer	318	SC

General Provider Information

NPI Number	:	1245372630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CASSANDRA GAY PHILLIPS ATC

Provider Business Mailing Address
First Line	:	25 MAUDIE ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-2213
Country	:	US
Telephone Number	:	864-294-3657
Fax Number	:

Provider Business Practice Location Address
First Line	:	FURMAN UNIVERSITY 3300 POINSETT HWY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29613-0001
Country	:	US
Telephone Number	:	864-294-2130
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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