Provider Demographics
NPI:1417386558
Name:PHELPS, STEPHANIE (DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 E AMBER LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1838
Mailing Address - Country:US
Mailing Address - Phone:480-213-5098
Mailing Address - Fax:
Practice Address - Street 1:5735 E MCKELLIPS RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2875
Practice Address - Country:US
Practice Address - Phone:480-269-7953
Practice Address - Fax:480-769-7269
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10004225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist