Healthcare Provider Details

I. General information

NPI: 1164013850
Provider Name (Legal Business Name): ANDREW H PHILLIPS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HIGHWAY 65 N STE 6
CLINTON AR
72031-6676
US

IV. Provider business mailing address

230 HIGHWAY 65 N STE 6
CLINTON AR
72031-6676
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-8881
  • Fax: 501-745-3113
Mailing address:
  • Phone: 501-745-8881
  • Fax: 501-745-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4608
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: