Provider Demographics
NPI:1588129472
Name:PRITZKER, PHILLIP JOSEPH SR (OTR)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JOSEPH
Last Name:PRITZKER
Suffix:SR
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:KRUM
Mailing Address - State:TX
Mailing Address - Zip Code:76249-4039
Mailing Address - Country:US
Mailing Address - Phone:214-766-3457
Mailing Address - Fax:
Practice Address - Street 1:605 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1263
Practice Address - Country:US
Practice Address - Phone:940-627-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103996225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist