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NPI Code Detail

MEDICARE: LISA ANN PHILLIPS DPT

MEDICARE: LISA ANN PHILLIPS 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
1225100000XPhysical Therapist12742WI

General Provider Information

NPI Number : 1306214457
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ANN PHILLIPS DPT
Provider Business Mailing Address
First Line : 8301 OLD SAUK RD
Second Line :
City : MIDDLETON
State : WI
Zip : 53562-4389
Country : US
Telephone Number : 608-662-8868
Fax Number :
Provider Business Practice Location Address
First Line : 8301 OLD SAUK RD
Second Line :
City : MIDDLETON
State : WI
Zip : 53562-4389
Country : US
Telephone Number : 608-662-8868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2015
Last Update Date : 09/07/2015

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