Healthcare Provider Details

I. General information

NPI: 1639190044
Provider Name (Legal Business Name): ANTHONY MICHAEL PHILLIPS D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 BESSIE AVENUE
TRACY CA
95376
US

IV. Provider business mailing address

413 GOLDEN LEAF CT
TRACY CA
95377-1110
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-4888
  • Fax: 209-835-6424
Mailing address:
  • Phone: 209-835-4888
  • Fax: 209-835-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: