Individual
DERRICK JESSE PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1616 RIDGE HAVEN DR APT 510, ARLINGTON, TX 76011-9097
(817) 658-8367
Mailing address
1616 RIDGE HAVEN DR APT 510, ARLINGTON, TX 76011-9097
(817) 658-8367
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1315697
TX
Other
Enumeration date
07/26/2022
Last updated
07/26/2022
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