Provider Demographics
NPI:1508079849
Name:POPPE, DEBRA ANN (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:POPPE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:RIDENOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 PLEASANT ST
Mailing Address - Street 2:SOUTH 2 ROOM 236
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1406
Mailing Address - Country:US
Mailing Address - Phone:515-241-6228
Mailing Address - Fax:515-241-8685
Practice Address - Street 1:2006 S ANKENY BLVD
Practice Address - Street 2:BUILDING 5
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8995
Practice Address - Country:US
Practice Address - Phone:515-289-9541
Practice Address - Fax:515-446-3642
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist