Basic Information
| Provider Information | |||||||||
| NPI: | 1205805041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOORHIS | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC, MSED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 VIENNA BLVD | ||||||||
| Address2: | |||||||||
| City: | DEKALB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601152651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157530211 | ||||||||
| FaxNumber: | 8157531874 | ||||||||
| Practice Location | |||||||||
| Address1: | NORTHERN ILLINOIS UNIVERSITY-HUSKIE STADIUM | ||||||||
| Address2: | 1245 STADIUM DRIVE SOUTH | ||||||||
| City: | DEKALB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601152854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157530211 | ||||||||
| FaxNumber: | 8157531874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 08/25/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 096000344 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.