Provider Demographics
NPI:1144330531
Name:ARMITAGE, PHILLIP DEAN (DHA, LSA, OPAC, CSA)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:DEAN
Last Name:ARMITAGE
Suffix:
Gender:M
Credentials:DHA, LSA, OPAC, CSA
Other - Prefix:DR
Other - First Name:DEAN
Other - Middle Name:PHILLIP
Other - Last Name:ARMITAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DHA, LSA, OPAC, CSA
Mailing Address - Street 1:418 LAKE VIEW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:418 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-9240
Practice Address - Country:US
Practice Address - Phone:281-352-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00382363AS0400X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT1978OtherATHLETIC TRAINER
TXSA00382OtherLICENSE SURGICAL ASSISTANT
TX3578OtherCERTIFIED SURGICAL ASSISTANT
TX000080709OtherNATIONAL ASSOCIATION OF ATHLETIC TRAINERS
TX754OtherOPA-C