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General NPI Number Information
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NPI Number | 1386291011
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Entity Type | Individual
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Provider Name | KATHY WYLIE PHILLIPS LMT 11386
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Gender | Female
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Dates
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Enumeration Date | 08/19/2019
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 324 E SAINT JOHN ST STE B
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City | SPARTANBURG
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State | SC
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Zip | 29302-1505
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Country | US
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Telephone | 864-214-5963
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Fax |
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Provider Business Mailing Address
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Address Line | 405 ROSE CORAL WAY
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City | DUNCAN
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State | SC
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Zip | 29334-8894
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Country | US
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Telephone | 864-839-2245
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 11386
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License Number State | SC
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