Provider Demographics
NPI:1952436529
Name:PHELPS, STEPHANIE J (STEPHANIE PHELPS AT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:PHELPS
Suffix:
Gender:F
Credentials:STEPHANIE PHELPS AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 S 3698 E
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-5102
Mailing Address - Country:US
Mailing Address - Phone:435-654-2255
Mailing Address - Fax:
Practice Address - Street 1:64 E 600 S
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2347
Practice Address - Country:US
Practice Address - Phone:435-654-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5490220-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer