MEDICARE: LISA COLE PHILLIPS LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0101	KY

General Provider Information

NPI Number	:	1184942542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA COLE PHILLIPS LMT

Provider Business Mailing Address
First Line	:	5000 BACK SQUARE DR STE A2
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-7411
Country	:	US
Telephone Number	:	270-316-1812
Fax Number	:	270-240-4500

Provider Business Practice Location Address
First Line	:	5000 BACK SQUARE DR STE A2
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-7411
Country	:	US
Telephone Number	:	270-316-1812
Fax Number	:	270-240-4500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2010
Last Update Date	:	05/10/2010

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Directions to “ LISA COLE PHILLIPS LMT” Practice Location

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