MEDICARE: RYDER PHILLIPS CFO

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	225000000X	Orthotic Fitter

General Provider Information

NPI Number	:	1346581519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYDER PHILLIPS CFO

Provider Business Mailing Address
First Line	:	2318 GULL RD
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-3619
Country	:	US
Telephone Number	:	269-345-1117
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 GULL RD
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-3619
Country	:	US
Telephone Number	:	269-345-1117
Fax Number	:

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

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	03/12/2013

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