Provider Demographics
NPI:1043581259
Name:PHELPS, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:PHELPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N MOJAVE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2407
Mailing Address - Country:US
Mailing Address - Phone:702-642-7070
Mailing Address - Fax:702-649-3906
Practice Address - Street 1:821 N MOJAVE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2407
Practice Address - Country:US
Practice Address - Phone:702-642-7070
Practice Address - Fax:702-649-3906
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner