Healthcare Provider Details

I. General information

NPI: 1598899908
Provider Name (Legal Business Name): CHERYL LYNN PHILLIPS LIC.MASSAGETHERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 MERIDIAN AVE E SUITE 9
EDGEWOOD WA
98371-1006
US

IV. Provider business mailing address

2121 MERIDIAN AVE E SUITE 9
EDGEWOOD WA
98371-1006
US

V. Phone/Fax

Practice location:
  • Phone: 253-568-6689
  • Fax: 253-568-6830
Mailing address:
  • Phone: 253-568-6689
  • Fax: 253-568-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00013812
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: