Provider Demographics
NPI:1811555352
Name:PHELPS, DAN
Entity Type:Individual
Prefix:
First Name:DAN
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 1:362 W SAINT GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3352
Mailing Address - Country:US
Mailing Address - Phone:435-652-0100
Mailing Address - Fax:801-652-0103
Practice Address - Street 1:362 W SAINT GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3352
Practice Address - Country:US
Practice Address - Phone:435-652-0100
Practice Address - Fax:801-652-0100
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist