Provider Demographics
NPI:1750798450
Name:DEARDORFF, ANN (DPT)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:DEARDORFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10192 N STATE ROAD 19
Mailing Address - Street 2:
Mailing Address - City:MACY
Mailing Address - State:IN
Mailing Address - Zip Code:46951-8042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10192 N STATE ROAD 19
Practice Address - Street 2:
Practice Address - City:MACY
Practice Address - State:IN
Practice Address - Zip Code:46951-8042
Practice Address - Country:US
Practice Address - Phone:765-437-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010729A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05010729AOtherPHYSICAL THERAPY LICENSE