Healthcare Provider Details

I. General information

NPI: 1649236944
Provider Name (Legal Business Name): KRISTEN NOELLE PHILLIPS ATC, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 W STATE ST
ALLIANCE OH
44601-5608
US

IV. Provider business mailing address

1465 WESTWOOD AVE
ALLIANCE OH
44601-3502
US

V. Phone/Fax

Practice location:
  • Phone: 330-829-2338
  • Fax:
Mailing address:
  • Phone: 740-755-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberAT001333
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number07725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: