Provider Demographics
NPI:1508244674
Name:GILLIAM, DEBORAH DELAN (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DELAN
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DELAN
Other - Middle Name:T
Other - Last Name:GILLIAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:200 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4559
Mailing Address - Country:US
Mailing Address - Phone:850-784-7724
Mailing Address - Fax:850-784-4711
Practice Address - Street 1:200 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4559
Practice Address - Country:US
Practice Address - Phone:850-784-7724
Practice Address - Fax:850-784-4711
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty