Provider Demographics
NPI:1124801014
Name:PHILLIPS, CURTIS NOLAN (PHD, PT)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:NOLAN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 OLD MAIN HL
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-6810
Mailing Address - Country:US
Mailing Address - Phone:435-797-0673
Mailing Address - Fax:
Practice Address - Street 1:765 NORTH 990 EAST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-6810
Practice Address - Country:US
Practice Address - Phone:435-797-0673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4808543-24012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics