Provider Demographics
NPI:1497730089
Name:NIELSEN, DEBBRA (PTA)
Entity Type:Individual
Prefix:
First Name:DEBBRA
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W GOLF RD
Mailing Address - Street 2:SUITE 68
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3929
Mailing Address - Country:US
Mailing Address - Phone:847-593-5511
Mailing Address - Fax:847-593-0872
Practice Address - Street 1:415 W GOLF RD
Practice Address - Street 2:SUITE 68
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3929
Practice Address - Country:US
Practice Address - Phone:847-593-5511
Practice Address - Fax:847-593-0872
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant