Healthcare Provider Details

I. General information

NPI: 1811181910
Provider Name (Legal Business Name): MICHAEL LAWRENCE PHILLIP PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S 21ST ST SUITE 120
COLORADO SPRINGS CO
80904-3762
US

IV. Provider business mailing address

830 N SHERMAN ST #206
DENVER CO
80203-2909
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-1110
  • Fax:
Mailing address:
  • Phone: 561-715-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070015934
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0012369
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: