Provider Demographics
NPI:1104345206
Name:PHILLIPS, JEFFREY M (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:8660 FERN AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5694
Mailing Address - Country:US
Mailing Address - Phone:318-631-7999
Mailing Address - Fax:318-631-9528
Practice Address - Street 1:2906 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5851
Practice Address - Country:US
Practice Address - Phone:318-746-5295
Practice Address - Fax:318-746-5297
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA08020R2251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics