Provider Demographics
NPI:1669683306
Name:DEBUCK, DEBRA SUE (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:DEBUCK
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:N6139 COUNTY ROAD P
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-2703
Mailing Address - Country:US
Mailing Address - Phone:262-728-9061
Mailing Address - Fax:262-728-1990
Practice Address - Street 1:N6139 COUNTY ROAD P
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-2703
Practice Address - Country:US
Practice Address - Phone:262-728-9061
Practice Address - Fax:262-728-1990
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1719-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist