Provider Demographics
NPI:1861509549
Name:PHELAN, MICHELLE ANN (ATC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANN
Last Name:PHELAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 WASHINGTON ST # 2
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5006
Mailing Address - Country:US
Mailing Address - Phone:201-216-5695
Mailing Address - Fax:201-216-8244
Practice Address - Street 1:1 CASTLE POINT TER
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5906
Practice Address - Country:US
Practice Address - Phone:201-216-5695
Practice Address - Fax:201-216-8244
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer