=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891269809
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH A. TALBOT PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2019
-----------------------------------------------------
Last Update Date | 01/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 990 BAYLEY DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45233-1664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-347-4019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7936 SURREYWOOD DR
-----------------------------------------------------
City | NORTH BEND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45052-9618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-265-0579
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT-005275
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------