Provider Demographics
NPI:1639333057
Name:DAVERS, DEBRA SUE (PTA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:DAVERS
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 1:2020 N COUNTY ROAD 450 W
Mailing Address - Street 2:
Mailing Address - City:FREETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47235-9739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 S SUGAR ST
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-2066
Practice Address - Country:US
Practice Address - Phone:812-358-2504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002055A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant