MEDICARE: SHARILYNN R DEBOER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070015010	IL
2	225100000X	Physical Therapist	05013218A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	568150	OTHER	IL	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	367885100	OTHER	IL	US DEPT OF LABOR
3	1619908	OTHER	IL	BCBS IL GROUP NUMBER
4	1623066	OTHER	IL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1619914264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARILYNN R DEBOER PT

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 830
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-943-7850
Fax Number	:	312-943-0057

Provider Business Practice Location Address
First Line	:	6625 W LINCOLN HWY
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-9678
Country	:	US
Telephone Number	:	219-440-5360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	10/18/2019

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Directions to “ SHARILYNN R DEBOER PT” Practice Location

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