Provider Demographics
NPI:1730254202
Name:GULBRANDSON, DEBORAH M (PT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:M
Last Name:GULBRANDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2615 3 OAKS RD 1A
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-6123
Mailing Address - Country:US
Mailing Address - Phone:847-516-8095
Mailing Address - Fax:847-516-8098
Practice Address - Street 1:2615 THREE OAKS RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013
Practice Address - Country:US
Practice Address - Phone:847-516-8095
Practice Address - Fax:847-516-8098
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070002571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211053Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILK15126Medicare UPIN