Provider Demographics
NPI:1346718327
Name:PARRISH, DEBORA SUE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:SUE
Last Name:PARRISH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:DEBORA
Other - Middle Name:SUE
Other - Last Name:SLAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:933 SUNSET VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-8429
Mailing Address - Country:US
Mailing Address - Phone:309-368-3015
Mailing Address - Fax:
Practice Address - Street 1:1250 W CARL SANDBURG DR
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1329
Practice Address - Country:US
Practice Address - Phone:309-344-5400
Practice Address - Fax:309-344-7347
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.002375225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant