Provider Demographics
NPI:1093742397
Name:CAIRES NELSON, DEBORA (PT)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:CAIRES NELSON
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 1:2200 IRONWOOD PL
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2610
Mailing Address - Country:US
Mailing Address - Phone:208-667-6486
Mailing Address - Fax:208-676-8276
Practice Address - Street 1:2200 IRONWOOD PL
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2610
Practice Address - Country:US
Practice Address - Phone:208-667-6486
Practice Address - Fax:208-676-8276
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010138360OtherBLUE SHIELD
ID806161000Medicaid
WA0161551OtherLABOR AND INDUSTRY
IDT5410OtherBLUE CROSS
1653673Medicare ID - Type Unspecified