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Individual

LUCAS PHILLIPS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MED, ATC, LAT

Contact information

Practice address
1001 E 17TH ST, BLOOMINGTON, IN 47408-1590
(812) 855-7916
Mailing address
155 MIAMI ST, TIFFIN, OH 44883-2109
(419) 448-3480

Taxonomy

Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
3982
OH
2255A2300X
Athletic Trainer
36001524A
IN

Other

Enumeration date
11/01/2011
Last updated
03/27/2018
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