Provider Demographics
NPI:1376230615
Name:CRADDOCK, DEBLIA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DEBLIA
Middle Name:
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DEBI
Other - Middle Name:
Other - Last Name:CRADDOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:9320 TELSTAR AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2816
Mailing Address - Country:US
Mailing Address - Phone:626-569-6329
Mailing Address - Fax:
Practice Address - Street 1:9320 TELSTAR AVE STE 226
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2816
Practice Address - Country:US
Practice Address - Phone:626-569-6329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT137672251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics