Individual
STACEY MICHELE PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PT
Contact information
Practice address
46 W COLT SQUARE DR, FAYETTEVILLE, AR 72703-2813
(479) 582-2740
(479) 582-2746
Mailing address
46 W COLT SQUARE DR, FAYETTEVILLE, AR 72703-2813
(479) 582-2740
(479) 582-2746
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT 2212
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135927721
—
AR
Enumeration date
01/07/2009
Last updated
01/07/2009
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