Healthcare Provider Details

I. General information

NPI: 1619914264
Provider Name (Legal Business Name): SHARILYNN R DEBOER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 W LINCOLN HWY
CROWN POINT IN
46307-9678
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE 830
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 219-440-5360
  • Fax:
Mailing address:
  • Phone: 312-943-7850
  • Fax: 312-943-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070015010
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013218A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: