Provider Demographics
NPI:1619212727
Name:HANCOCK, DEBRA LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:HANCOCK
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 1:1381 CAMPBELL LN
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1049
Mailing Address - Country:US
Mailing Address - Phone:270-843-0587
Mailing Address - Fax:
Practice Address - Street 1:1381 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1049
Practice Address - Country:US
Practice Address - Phone:270-843-0587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant