Provider Demographics
NPI:1336497692
Name:VANDOVER, DEBBIE KAY (PT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:KAY
Last Name:VANDOVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9521
Mailing Address - Country:US
Mailing Address - Phone:503-665-4799
Mailing Address - Fax:
Practice Address - Street 1:2160 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-9521
Practice Address - Country:US
Practice Address - Phone:503-665-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist