Provider Demographics
NPI:1679267686
Name:PHELPS, JESSALYN ELANA (DPT)
Entity type:Individual
Prefix:DR
First Name:JESSALYN
Middle Name:ELANA
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 1:2295 WYATT ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7793
Mailing Address - Country:US
Mailing Address - Phone:850-910-2416
Mailing Address - Fax:
Practice Address - Street 1:5827 US-90
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583
Practice Address - Country:US
Practice Address - Phone:850-983-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist