Provider Demographics
NPI:1710939236
Name:ANDERSON, DEBORAH K (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:K
Last Name:ANDERSON
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 1:5201 WALNUT AVENUE
Mailing Address - Street 2:STE 4
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4025
Mailing Address - Country:US
Mailing Address - Phone:630-964-4707
Mailing Address - Fax:630-964-4797
Practice Address - Street 1:5201 WALNUT AVENUE
Practice Address - Street 2:STE 4
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4025
Practice Address - Country:US
Practice Address - Phone:630-964-4707
Practice Address - Fax:630-964-4797
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDA46560299POtherE.I. CREDENTIAL NUMBER