Provider Demographics
NPI:1972723864
Name:PHILLIPS, JAMES MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ALBANY
Mailing Address - Street 2:FRANCISCAN ST. FRANCIS HOSPITAL
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107
Mailing Address - Country:US
Mailing Address - Phone:371-528-8572
Mailing Address - Fax:
Practice Address - Street 1:8111 S. EMERSON AVE
Practice Address - Street 2:ST. FRANCIS HOSPITAL
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-780-3750
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003081A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist