MEDICARE: MRS. MICHELLE V PHILLIPS MS, RCEP, CDE

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	224Y00000X	Clinical Exercise Physiologist

General Provider Information

NPI Number	:	1679845275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE V PHILLIPS MS, RCEP, CDE

Provider Business Mailing Address
First Line	:	4050 W MEMORIAL RD
Second Line	:	INTENSIVE CARDIAC REHAB
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8382
Country	:	US
Telephone Number	:	405-608-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 W MEMORIAL RD
Second Line	:	INTENSIVE CARDIAC REHAB
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8382
Country	:	US
Telephone Number	:	405-608-3200
Fax Number	:

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

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	04/02/2017

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