Provider Demographics
NPI:1124675301
Name:KELLOGG, PHILLIP SCHUYLER (DPT)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:SCHUYLER
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E TRINITY PL UNIT 1419
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3493
Mailing Address - Country:US
Mailing Address - Phone:607-220-3524
Mailing Address - Fax:
Practice Address - Street 1:613 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2517
Practice Address - Country:US
Practice Address - Phone:607-220-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist