Provider Demographics
NPI:1073558540
Name:HERSHBERGER, DEBRA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-3552
Mailing Address - Country:US
Mailing Address - Phone:660-646-1127
Mailing Address - Fax:
Practice Address - Street 1:740 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3042
Practice Address - Country:US
Practice Address - Phone:660-646-0022
Practice Address - Fax:660-646-1553
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7332708OtherAETNA
MO483481438Medicaid
MO34256014OtherBLUE CROSS BLUE SHIELD
MOP00157305OtherRAIL ROAD MEDICARE
MOP00157305OtherRAIL ROAD MEDICARE
MOR34B375Medicare ID - Type Unspecified