Provider Demographics
NPI:1386859452
Name:KOON, DEBRA G (PT,ATC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:G
Last Name:KOON
Suffix:
Gender:F
Credentials:PT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20429
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35402-0429
Mailing Address - Country:US
Mailing Address - Phone:205-349-0995
Mailing Address - Fax:205-349-0995
Practice Address - Street 1:15631 QUAIL PT
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-2614
Practice Address - Country:US
Practice Address - Phone:205-349-0995
Practice Address - Fax:205-349-0995
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51076565OtherBLUE CROSS BLUE SHIELD AL
AL6410032OtherUNITEDHEALTH CARE
AL6410032OtherUNITEDHEALTH CARE