Provider Demographics
NPI:1225743669
Name:PHILLIPS, JOSEPHINE GRAY (DPT)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:GRAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:GRAY
Other - Last Name:MOOTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8607
Mailing Address - Country:US
Mailing Address - Phone:972-724-2400
Mailing Address - Fax:972-724-2495
Practice Address - Street 1:413 W BETHEL RD STE 400
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4477
Practice Address - Country:US
Practice Address - Phone:972-304-9100
Practice Address - Fax:972-304-9048
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1373280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist