Provider Demographics
NPI:1124758677
Name:PHILLIPS, KAREN LORD (PT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LORD
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2090 CHICKEN RD
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31022-2642
Mailing Address - Country:US
Mailing Address - Phone:912-375-8174
Mailing Address - Fax:
Practice Address - Street 1:212 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2547
Practice Address - Country:US
Practice Address - Phone:478-275-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist