Provider Demographics
NPI:1386291011
Name:PHILLIPS, KATHY WYLIE (LMT 11386)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:WYLIE
Last Name:PHILLIPS
Suffix:
Gender:
Credentials:LMT 11386
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 ROSE CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8894
Mailing Address - Country:US
Mailing Address - Phone:864-839-2245
Mailing Address - Fax:
Practice Address - Street 1:324 E SAINT JOHN ST STE B
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1505
Practice Address - Country:US
Practice Address - Phone:864-214-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11386225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist