Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5105 | OR |
N | 2251P0200X | Physical Therapist - Pediatrics | 5105 | OR |
NPI | 1053383430 |
---|---|
Provider Name | Amy Leigh Phelps |
First Address | Dundee, OR 97115-8601 |
Second Address | Newberg, OR 97132-2198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 17/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005727 | (05) | OR |