MEDICARE: MRS. LAURA J PHILLIPS MPT

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	PT011541	OH
2	225100000X	Physical Therapist	070-012893	IL
3	225100000X	Physical Therapist	3543	OR
4	225100000X	Physical Therapist	38313	CA
5	225100000X	Physical Therapist	1223619	TX

General Provider Information

NPI Number	:	1568668523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA J PHILLIPS MPT

Provider Business Mailing Address
First Line	:	114 LINDENBERRY CIR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77389-5097
Country	:	US
Telephone Number	:	330-247-8752
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 LINDENBERRY CIR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77389-5097
Country	:	US
Telephone Number	:	330-247-8752
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	01/27/2013

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