Individual
MICHAEL LAWRENCE PHILLIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
600 S 21ST ST, SUITE 120, COLORADO SPRINGS, CO 80904-3762
(719) 634-1110
Mailing address
830 N SHERMAN ST, #206, DENVER, CO 80203-2909
(561) 715-1515
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070015934
IL
225100000X
Physical Therapist
Primary
PTL.0012369
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619908
BCBS IL GROUP
IL
01
—
567700
MEDICARE GROUP NUMBER
IL
01
—
568080
MEDICARE GROUP NUMBER
IL
01
—
568150
MEDICARE GROUP NUMBER
IL
01
—
CD3789
MEDICARE RAILROAD GROUP NUMBER
IL
01
—
P00624023
MEDICARE RAILROAD
IL
Enumeration date
08/31/2007
Last updated
03/29/2016
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