MEDICARE: HALEY C PHILLIPS PT, DPT, IBCLC

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	PT014422	OH
2	2081P0010X	Pediatric Rehabilitation Medicine Physician	PT.014422	OH
3	174N00000X	Lactation Consultant (Non-RN)	L--320241	OH

General Provider Information

NPI Number	:	1790117224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY C PHILLIPS PT, DPT, IBCLC

Provider Business Mailing Address
First Line	:	3349 WILBUR DR
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-4504
Country	:	US
Telephone Number	:	419-204-7342
Fax Number	:

Provider Business Practice Location Address
First Line	:	3349 WILBUR DR
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-4504
Country	:	US
Telephone Number	:	419-204-7342
Fax Number	:

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	01/23/2026

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