NPI 1073065017

Fannie Phillips, LMT

Practitioner Specialist Gresham, OR

Practice location

Address: 1748 NW Fairview Dr, Gresham, OR 97030-3842
Phone: (503) 492-3910

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 15141 (OR)

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Registry record

NPI: 1073065017
Entity type: Individual
Sex (as registered): Female
NPI issued: 25 Oct 2016
Record last updated: 25 Oct 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.