Healthcare Provider Details

I. General information

NPI: 1508830928
Provider Name (Legal Business Name): DEBRA L SCANLON PTA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 INDIANAPOLIS BLVD
SCHERERVILLE IN
46375-1277
US

IV. Provider business mailing address

7540 W 92ND AVE
CROWN POINT IN
46307-7453
US

V. Phone/Fax

Practice location:
  • Phone: 219-322-1600
  • Fax:
Mailing address:
  • Phone: 219-365-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002294A
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36000119A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: