Provider Demographics
NPI:1891968111
Name:MERRICK, DEBORAH SUE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SUE
Last Name:MERRICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:SUE
Other - Last Name:MERRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1219 105TH AVE W
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55808-1728
Mailing Address - Country:US
Mailing Address - Phone:218-626-1675
Mailing Address - Fax:
Practice Address - Street 1:1219 105TH AVE W
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55808-1728
Practice Address - Country:US
Practice Address - Phone:218-626-1675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI532-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant