Healthcare Provider Details

I. General information

NPI: 1639333057
Provider Name (Legal Business Name): DEBRA SUE DAVERS P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S SUGAR ST
BROWNSTOWN IN
47220-2066
US

IV. Provider business mailing address

2020 N COUNTY ROAD 450 W
FREETOWN IN
47235-9739
US

V. Phone/Fax

Practice location:
  • Phone: 812-358-2504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002055A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: