Healthcare Provider Details

I. General information

NPI: 1881648582
Provider Name (Legal Business Name): ARKADUISZ M DEBICKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 MISHAWAKA AVE
SOUTH BEND IN
46615-2352
US

IV. Provider business mailing address

524 E MCKINLEY AVE SUITE 1
MISHAWAKA IN
46545
US

V. Phone/Fax

Practice location:
  • Phone: 574-255-8730
  • Fax:
Mailing address:
  • Phone: 574-255-8730
  • Fax: 574-255-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005298A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: