Provider Demographics
NPI:1306149281
Name:PHELAN, ERIN ELLA (LMT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELLA
Last Name:PHELAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 SW 257TH AVE
Mailing Address - Street 2:147
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-7433
Mailing Address - Country:US
Mailing Address - Phone:253-389-1710
Mailing Address - Fax:
Practice Address - Street 1:17223 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-1240
Practice Address - Country:US
Practice Address - Phone:503-760-0778
Practice Address - Fax:503-760-0753
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17754172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist