MEDICARE: AERIELL PHILLIPS LMP

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	225700000X	Massage Therapist	MT144591	TX

General Provider Information

NPI Number	:	1790259711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AERIELL PHILLIPS LMP

Provider Business Mailing Address
First Line	:	39 N LAKERIDGE CIR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-4056
Country	:	US
Telephone Number	:	206-850-7135
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 N LAKERIDGE CIR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-4056
Country	:	US
Telephone Number	:	206-850-7135
Fax Number	:

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

Provider Enumeration Date	:	01/12/2019
Last Update Date	:	06/16/2026

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