Healthcare Provider Details

I. General information

NPI: 1295008605
Provider Name (Legal Business Name): ROBIN D PHILLIPS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 CORPORATE CENTER CT SE SUITE D
LACEY WA
98503-5952
US

IV. Provider business mailing address

1519 132ND ST SE SUITE A
EVERETT WA
98208-7203
US

V. Phone/Fax

Practice location:
  • Phone: 360-352-7352
  • Fax: 360-352-7680
Mailing address:
  • Phone: 425-357-9380
  • Fax: 425-357-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60226468
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: