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General NPI Number Information
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NPI Number | 1205805041
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Entity Type | Individual
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Provider Name | PHILLIP EDWARD VOORHIS ATC, MSED.
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Gender | Male
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | NORTHERN ILLINOIS UNIVERSITY-HUSKIE STADIUM 1245 STADIUM DRIVE SOUTH
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City | DEKALB
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State | IL
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Zip | 60115-2854
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Country | US
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Telephone | 815-753-0211
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Fax | 815-753-1874
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Provider Business Mailing Address
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Address Line | 836 VIENNA BLVD
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City | DEKALB
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State | IL
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Zip | 60115-2651
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Country | US
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Telephone | 815-753-0211
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Fax | 815-753-1874
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096000344
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License Number State | IL
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