Provider Demographics
NPI:1043748700
Name:PHALEN, DEVYN TAYLOR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DEVYN
Middle Name:TAYLOR
Last Name:PHALEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6974 OAK DR APT 2105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-4417
Mailing Address - Country:US
Mailing Address - Phone:210-577-9642
Mailing Address - Fax:
Practice Address - Street 1:311 W NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1887
Practice Address - Country:US
Practice Address - Phone:210-824-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1289839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist