Individual
LARRY S PHIPPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS, CTRS
Contact information
Practice address
30901 PALMER RD, WESTLAND, MI 48186-9529
(734) 367-8477
(734) 722-9524
Mailing address
20018 CENTRALIA, REDFORD, MI 48240-1103
(313) 532-4451
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
23662
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508883299
WRPH
MI
01
—
23662
CERTIFICATION
—
Enumeration date
08/15/2007
Last updated
08/15/2007
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