MEDICARE: MICHAEL LAWRENCE PHILLIP PT

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	070015934	IL
2	225100000X	Physical Therapist	PTL.0012369	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	568150	OTHER	IL	MEDICARE GROUP NUMBER
3	CD3789	OTHER	IL	MEDICARE RAILROAD GROUP NUMBER
4	567700	OTHER	IL	MEDICARE GROUP NUMBER
5	P00624023	OTHER	IL	MEDICARE RAILROAD
6	568080	OTHER	IL	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1619908	OTHER	IL	BCBS IL GROUP

General Provider Information

NPI Number	:	1811181910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LAWRENCE PHILLIP PT

Provider Business Mailing Address
First Line	:	830 N SHERMAN ST
Second Line	:	#206
City	:	DENVER
State	:	CO
Zip	:	80203-2909
Country	:	US
Telephone Number	:	561-715-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S 21ST ST
Second Line	:	SUITE 120
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3762
Country	:	US
Telephone Number	:	719-634-1110
Fax Number	:

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	03/29/2016

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Directions to “ MICHAEL LAWRENCE PHILLIP PT” Practice Location

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