Provider Demographics
NPI:1417975566
Name:MITCHELL, DEBORAH A (PT, DPT, MPT)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PT, DPT, MPT
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:SALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, MPT
Mailing Address - Street 1:5435 BULL VALLEY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-2209
Mailing Address - Country:US
Mailing Address - Phone:815-451-4502
Mailing Address - Fax:815-977-8467
Practice Address - Street 1:5435 BULL VALLEY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-2209
Practice Address - Country:US
Practice Address - Phone:815-451-4502
Practice Address - Fax:815-977-8467
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK29538Medicare UPIN
ILK29537Medicare UPIN