Provider Demographics
NPI:1538258579
Name:DARR, DEBORAH (PT)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:DARR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1500
Mailing Address - Country:US
Mailing Address - Phone:312-266-1014
Mailing Address - Fax:312-654-0031
Practice Address - Street 1:900 N LAKE SHORE DR
Practice Address - Street 2:SUITE 803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1500
Practice Address - Country:US
Practice Address - Phone:312-266-1014
Practice Address - Fax:312-654-0031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622913OtherBLUE CROSS BLUE SHIELD
IL01622913OtherBLUE CROSS BLUE SHIELD