Healthcare Provider Details

I. General information

NPI: 1124251426
Provider Name (Legal Business Name): MICHAEL PATRICK PHILLIPS L.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E TULARE AVE
VISALIA CA
93292-3629
US

IV. Provider business mailing address

520 E TULARE AVE
TULARE CA
93274-4221
US

V. Phone/Fax

Practice location:
  • Phone: 559-623-0900
  • Fax:
Mailing address:
  • Phone: 559-600-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number34111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: