Provider Demographics
NPI:1396144598
Name:PHILLIPS, JACQUELINE (MS, ATC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5485 MCGINNIS CT
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-1371
Mailing Address - Country:US
Mailing Address - Phone:215-913-0521
Mailing Address - Fax:
Practice Address - Street 1:5485 MCGINNIS CT
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-1371
Practice Address - Country:US
Practice Address - Phone:215-913-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0000672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer