Corey Phipps-Davisson

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

09165 Issued in OR

Practice address

319 NE Russet St
Portland, OR 97211-2815

Phone

(503) 289-5571

NPI assigned

Apr 30, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430352000000",
    "number": "1073990891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 SW 6TH ST",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986043016",
            "telephone_number": "503-913-8696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 NE RUSSET ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972112815",
            "telephone_number": "503-289-5571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHIPPS-DAVISSON",
        "first_name": "COREY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-30",
        "last_updated": "2015-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160548479",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OR",
            "license": "09165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LICENSE",
            "identifier": "P160548479",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LICENSE",
            "identifier": "09165",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Phillips, DO
• Victoria Phillips, CADC R
• Whitney Phillips, D.C.
• Helen C. Philpot, LMT
• Edward S Phinney Jr., MD
• Phoebe Rich, MD LLC
• Phoenix Chiropractic, LLC
• Phoenix Rising Psychology
• Phoenix Rising Therapy, LLC
• Phoenix Services, Inc.

• Physical Therapy Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Physical Therapy Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.