Provider Demographics
NPI:1356778559
Name:SHORT, DEBORAH E (MPT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:SHORT
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 1:2120 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-2191
Mailing Address - Country:US
Mailing Address - Phone:217-423-4300
Mailing Address - Fax:217-423-3428
Practice Address - Street 1:2120 N 27TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-2191
Practice Address - Country:US
Practice Address - Phone:217-423-4300
Practice Address - Fax:217-423-3428
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.011321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist