Provider Demographics
NPI:1902395460
Name:FILD, DEBORAH S (MPT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:FILD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 220TH AVE
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-8596
Mailing Address - Country:US
Mailing Address - Phone:231-250-3402
Mailing Address - Fax:
Practice Address - Street 1:600 DENMARK ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:MI
Practice Address - Zip Code:49304-7500
Practice Address - Country:US
Practice Address - Phone:231-745-4648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist