Provider Demographics
NPI:1609937424
Name:FORREST, DEBORAH CLAYTON (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:CLAYTON
Last Name:FORREST
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 1:6531 PORT REPUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-6012
Mailing Address - Country:US
Mailing Address - Phone:540-421-3989
Mailing Address - Fax:540-289-3876
Practice Address - Street 1:6531 PORT REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-6012
Practice Address - Country:US
Practice Address - Phone:540-421-3989
Practice Address - Fax:540-289-3876
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA194035OtherANTHEM BLUE CROSS AND BLU