Individual
MRS. CONNIE ELLIS PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5346
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103183C572
UCARE MN
MN
01
—
448T1PH
BCBS OF MN
MN
01
—
6404803
MEDICA
MN
01
—
983181027668
PREFERRED ONE
MN
01
—
H033
TRICARE
MN
01
—
HP42303
HEALTH PARTNERS
MN
Enumeration date
05/03/2006
Last updated
07/22/2011
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