Provider Demographics
NPI:1427703966
Name:PHELAN, JANE ELLEN (LMT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ELLEN
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 1:160 SW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3119
Mailing Address - Country:US
Mailing Address - Phone:954-574-5277
Mailing Address - Fax:754-227-7217
Practice Address - Street 1:160 SW 12TH AVE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3119
Practice Address - Country:US
Practice Address - Phone:954-574-5277
Practice Address - Fax:754-227-2717
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29694225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist