Provider Demographics
NPI:1952486706
Name:DEBOO, ED DARA (PT)
Entity Type:Individual
Prefix:MR
First Name:ED
Middle Name:DARA
Last Name:DEBOO
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 1:2114 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4140
Mailing Address - Country:US
Mailing Address - Phone:360-715-8686
Mailing Address - Fax:360-715-1680
Practice Address - Street 1:2114 JAMES ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4140
Practice Address - Country:US
Practice Address - Phone:360-715-8686
Practice Address - Fax:360-715-1680
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8801612Medicare ID - Type Unspecified