Provider Demographics
NPI:1972794477
Name:DURELL, DEANNA L (PT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:DURELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:L
Other - Last Name:MACAVOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 8004
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-8004
Mailing Address - Country:US
Mailing Address - Phone:715-847-2304
Mailing Address - Fax:715-847-2321
Practice Address - Street 1:5409 VERN HOLMES DR
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-8853
Practice Address - Country:US
Practice Address - Phone:715-344-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist