Provider Demographics
NPI:1619289592
Name:PHELPS, DEBRA COLLEEN (LMT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:COLLEEN
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:D.
Other - Middle Name:ELLIS
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:5451 MEADOW LARK DR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2317
Mailing Address - Country:US
Mailing Address - Phone:830-515-9204
Mailing Address - Fax:
Practice Address - Street 1:5451 MEADOW LARK DR
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-2317
Practice Address - Country:US
Practice Address - Phone:830-515-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT105635225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist