Provider Demographics
NPI:1669571725
Name:PHILIPS, SERGE GILBERT (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:SERGE
Middle Name:GILBERT
Last Name:PHILIPS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 NW 18TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3203
Mailing Address - Country:US
Mailing Address - Phone:954-442-8135
Mailing Address - Fax:
Practice Address - Street 1:9030 NW 18TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3203
Practice Address - Country:US
Practice Address - Phone:954-442-8135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 14558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 14558OtherPHYSICAL THERAPIST