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General NPI Number Information
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NPI Number | 1295934206
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Entity Type | Individual
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Provider Name | DEBORAH KONERDING PTA
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Gender | Female
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 404 WEST WILLOW ROAD
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City | DALE
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State | IN
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Zip | 47550
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Country | US
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Telephone | 812-937-4480
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Fax |
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Provider Business Mailing Address
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Address Line | 9858 E COUNTY ROAD 1400 N
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City | LAMAR
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State | IN
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Zip | 47550-7322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06002982A
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License Number State | IN
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