Basic Information
| Provider Information | |||||||||
| NPI: | 1770872673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | JILL | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2626 GLENNWOOD AVE | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276080000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197819565 | ||||||||
| FaxNumber: | 9197819564 | ||||||||
| Practice Location | |||||||||
| Address1: | 2626 GLENNWOOD AVE | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276080000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197819565 | ||||||||
| FaxNumber: | 9197819564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2011 | ||||||||
| LastUpdateDate: | 03/31/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8475 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.