Provider Demographics
NPI:1437159050
Name:MCKIM, DEBORAH RAE (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RAE
Last Name:MCKIM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:RAE
Other - Last Name:CHRISTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:18 GINNA B DR
Mailing Address - Street 2:
Mailing Address - City:ROBESONIA
Mailing Address - State:PA
Mailing Address - Zip Code:19551-9668
Mailing Address - Country:US
Mailing Address - Phone:610-693-9631
Mailing Address - Fax:
Practice Address - Street 1:1011 W PENN AVE
Practice Address - Street 2:
Practice Address - City:ROBESONIA
Practice Address - State:PA
Practice Address - Zip Code:19551-9550
Practice Address - Country:US
Practice Address - Phone:610-589-2263
Practice Address - Fax:610-589-2232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-012229-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01907598Medicaid
PA060490QVSMedicare ID - Type Unspecified