Provider Demographics
NPI:1013205764
Name:ARMITAGE, DEBRA LEE (PTA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:ARMITAGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 SANDY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-1948
Mailing Address - Country:US
Mailing Address - Phone:708-747-5174
Mailing Address - Fax:
Practice Address - Street 1:17400 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1600
Practice Address - Country:US
Practice Address - Phone:708-335-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.000240172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker