Provider Demographics
NPI:1538596069
Name:PHILLIPS, DIXIE (LMT)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 MEMORIAL PKWY SW
Mailing Address - Street 2:SUITE #116
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5375
Mailing Address - Country:US
Mailing Address - Phone:256-585-0504
Mailing Address - Fax:
Practice Address - Street 1:3313 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE #116
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5375
Practice Address - Country:US
Practice Address - Phone:256-585-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2151225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist