Healthcare Provider Details

I. General information

NPI: 1194241679
Provider Name (Legal Business Name): CARTER RYAN PHILLIPS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 SE 27TH ST STE 112
MERCER ISLAND WA
98040-3060
US

IV. Provider business mailing address

850 W IRONWOOD DR STE 202
COEUR D ALENE ID
83814-4903
US

V. Phone/Fax

Practice location:
  • Phone: 206-230-8320
  • Fax:
Mailing address:
  • Phone: 208-601-6038
  • Fax: 208-664-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number293464
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61648478
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7471880
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: