Healthcare Provider Details

I. General information

NPI: 1386291011
Provider Name (Legal Business Name): KATHY WYLIE PHILLIPS LMT 11386
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E SAINT JOHN ST STE B
SPARTANBURG SC
29302-1505
US

IV. Provider business mailing address

405 ROSE CORAL WAY
DUNCAN SC
29334-8894
US

V. Phone/Fax

Practice location:
  • Phone: 864-214-5963
  • Fax:
Mailing address:
  • Phone: 864-839-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11386
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: