Provider Demographics
NPI:1326269705
Name:WALLEN, DEBORAH DEVOL
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DEVOL
Last Name:WALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 GOLDEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8733
Mailing Address - Country:US
Mailing Address - Phone:239-566-7931
Mailing Address - Fax:
Practice Address - Street 1:6160 GOLDEN OAKS LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8733
Practice Address - Country:US
Practice Address - Phone:239-566-7931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3547OtherPHYSICAL THERAPY LICENSE
FLU4677AMedicare NSC