Provider Demographics
NPI:1508830928
Name:SCANLON, DEBRA L (PTA, ATC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:L
Last Name:SCANLON
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7453
Mailing Address - Country:US
Mailing Address - Phone:219-365-1174
Mailing Address - Fax:
Practice Address - Street 1:221 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1277
Practice Address - Country:US
Practice Address - Phone:219-322-1600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
06002294A225200000X
IN36000119A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer