Provider Demographics
NPI:1467451369
Name:LAVENDER, DEBORAH (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLONNADE CTR
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4328
Mailing Address - Country:US
Mailing Address - Phone:314-821-6006
Mailing Address - Fax:314-821-6005
Practice Address - Street 1:1133 COLONNADE CTR
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-4328
Practice Address - Country:US
Practice Address - Phone:314-821-6006
Practice Address - Fax:314-821-6005
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2243013OtherFIRST HEALTH
MO9195935OtherPHCS
MO7635608OtherAETNA
MO690261OtherHEALTHLINK
MO194278OtherBLUE CROSS/BLUE SHIELD