Provider Demographics
NPI:1386311751
Name:PHILLIPS PREVATT, ANNA DANIELLE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:DANIELLE
Last Name:PHILLIPS PREVATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 SILCOX RD
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36312-5356
Mailing Address - Country:US
Mailing Address - Phone:334-596-6632
Mailing Address - Fax:
Practice Address - Street 1:2155 SILCOX RD
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:AL
Practice Address - Zip Code:36312-5356
Practice Address - Country:US
Practice Address - Phone:334-596-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21556225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant