Healthcare Provider Details

I. General information

NPI: 1669739702
Provider Name (Legal Business Name): JASON RYAN PHILLIPS L.P., C.P. CFTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 UNIVERSITY AVE
LUBBOCK TX
79423-2125
US

IV. Provider business mailing address

7619 UNIVERSITY AVE
LUBBOCK TX
79423-2125
US

V. Phone/Fax

Practice location:
  • Phone: 806-799-1518
  • Fax: 806-799-5462
Mailing address:
  • Phone: 806-799-1518
  • Fax: 806-799-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number252
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: