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General NPI Number Information
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NPI Number | 1558336297
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Entity Type | Individual
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Provider Name | MARK LYNN PHILLIPS A.T.C., L.A.T.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 RAIDER CIRCLE NORTHBROOK HIGH SCHOOL
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City | HOUSTON
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State | TX
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Zip | 77080
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Country | US
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Telephone | 713-365-4430
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Fax |
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Provider Business Mailing Address
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Address Line | 21610 PARKER RD
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City | TOMBALL
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State | TX
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Zip | 77377-6037
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Country | US
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Telephone | 281-255-3970
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | AT0481
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License Number State | TX
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