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General NPI Number Information
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NPI Number | 1740900612
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Entity Type | Individual
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Provider Name | DEMETRIA D PHILLIPS
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Gender | Female
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 5215 FM 1960 RD W
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City | HOUSTON
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State | TX
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Zip | 77069-4414
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Country | US
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Telephone | 337-570-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 10144 WILD HOLLOW LN
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City | HOUSTON
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State | TX
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Zip | 77088-2150
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Country | US
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Telephone | 337-570-0712
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 1602217
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 1602217
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License Number State | TX
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