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General NPI Number Information
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NPI Number | 1619914264
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Entity Type | Individual
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Provider Name | SHARILYNN R DEBOER PT
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Gender | Female
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 6625 W LINCOLN HWY
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City | CROWN POINT
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State | IN
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Zip | 46307-9678
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Country | US
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Telephone | 219-440-5360
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Fax |
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR SUITE 830
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-943-7850
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Fax | 312-943-0057
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070015010
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05013218A
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License Number State | IN
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