MEDICARE: WENDY JILL PHILLIPS PT

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	225100000X	Physical Therapist	8475	NC

General Provider Information

NPI Number	:	1770872673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY JILL PHILLIPS PT

Provider Business Mailing Address
First Line	:	2626 GLENNWOOD AVE
Second Line	:	SUITE 160
City	:	RALEIGH
State	:	NC
Zip	:	27608-0000
Country	:	US
Telephone Number	:	919-781-9565
Fax Number	:	919-781-9564

Provider Business Practice Location Address
First Line	:	2626 GLENNWOOD AVE
Second Line	:	SUITE 160
City	:	RALEIGH
State	:	NC
Zip	:	27608-0000
Country	:	US
Telephone Number	:	919-781-9565
Fax Number	:	919-781-9564

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

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/31/2011

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