Provider Demographics
NPI:1134661887
Name:PHILLIPS, RHONDA (RT (R))
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 LORRIE LN
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-1660
Mailing Address - Country:US
Mailing Address - Phone:580-916-2179
Mailing Address - Fax:
Practice Address - Street 1:2807 LORRIE LN
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-1660
Practice Address - Country:US
Practice Address - Phone:580-916-2179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4560742471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography