MEDICARE: SUNNIL S PHILLIP

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	225200000X	Physical Therapy Assistant	014409	AZ

General Provider Information

NPI Number	:	1790520534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNNIL S PHILLIP

Provider Business Mailing Address
First Line	:	2141 E CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4764
Country	:	US
Telephone Number	:	602-595-6180
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 E CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4764
Country	:	US
Telephone Number	:	602-595-6180
Fax Number	:

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

Provider Enumeration Date	:	06/25/2024
Last Update Date	:	06/25/2024

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Directions to “ SUNNIL S PHILLIP ” Practice Location

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