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Individual
MR. FREDERICK MASON PHELPS
Active
Individual
MR. FREDERICK MASON PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
003524
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004066973
—
CT
01
—
080003524CT01
BCBS
CT
Enumeration date
08/07/2006
Last updated
03/22/2017
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