Healthcare Provider Details

I. General information

NPI: 1043404213
Provider Name (Legal Business Name): MARC D PHILLIPS MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12229 VOYAGER PKWY STE 150
COLORADO SPRINGS CO
80921-3790
US

IV. Provider business mailing address

7622 MCLAUGHLIN RD
PEYTON CO
80831-4710
US

V. Phone/Fax

Practice location:
  • Phone: 719-488-0120
  • Fax:
Mailing address:
  • Phone: 719-495-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9745
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0009745
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: