MEDICARE: ROBERT PHILLIPS MS, ATC

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	2255A2300X	Athletic Trainer	0126000817	VA

General Provider Information

NPI Number	:	1275941866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT PHILLIPS MS, ATC

Provider Business Mailing Address
First Line	:	204 W WASHINGTON ST
Second Line	:
City	:	LEXINGTON
State	:	VA
Zip	:	24450-2116
Country	:	US
Telephone Number	:	540-958-0938
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 W WASHINGTON ST
Second Line	:
City	:	LEXINGTON
State	:	VA
Zip	:	24450-2116
Country	:	US
Telephone Number	:	540-958-0938
Fax Number	:

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

Provider Enumeration Date	:	07/26/2014
Last Update Date	:	07/26/2014

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