Provider Demographics
NPI:1619914264
Name:DEBOER, SHARILYNN R (PT)
Entity Type:Individual
Prefix:
First Name:SHARILYNN
Middle Name:R
Last Name:DEBOER
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 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 830
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-943-7850
Mailing Address - Fax:312-943-0057
Practice Address - Street 1:6625 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9678
Practice Address - Country:US
Practice Address - Phone:219-440-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015010225100000X
IN05013218A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL367885100OtherUS DEPT OF LABOR
IL568150OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP NUMBER
IL1623066OtherBCBS PROVIDER NUMBER
IL567770Medicare ID - Type UnspecifiedMEDICARE GROUP
IL568150OtherMEDICARE GROUP NUMBER
IL367885100OtherUS DEPT OF LABOR
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP
ILK28445Medicare PIN