Healthcare Provider Details

I. General information

NPI: 1225393549
Provider Name (Legal Business Name): CHRISTINA LYNN PHILLIPS CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21908 GOLDEN STAR BLVD
TEHACHAPI CA
93561-9428
US

IV. Provider business mailing address

21908 GOLDEN STAR BLVD
TEHACHAPI CA
93561-9428
US

V. Phone/Fax

Practice location:
  • Phone: 661-972-1503
  • Fax:
Mailing address:
  • Phone: 661-972-1503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number008884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: