Provider Demographics
NPI:1750502449
Name:DEBNER, GARY DEAN (PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DEAN
Last Name:DEBNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18813 HWY 1
Mailing Address - Street 2:
Mailing Address - City:KEOSAUQUA
Mailing Address - State:IA
Mailing Address - Zip Code:52565
Mailing Address - Country:US
Mailing Address - Phone:319-293-3954
Mailing Address - Fax:319-293-3142
Practice Address - Street 1:18813 HWY 1
Practice Address - Street 2:
Practice Address - City:KEOSAUQUA
Practice Address - State:IA
Practice Address - Zip Code:52565
Practice Address - Country:US
Practice Address - Phone:319-293-3954
Practice Address - Fax:319-293-3142
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist