Basic Information
| Provider Information | |||||||||
| NPI: | 1194131862 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DEKKER | ||||||||
| FirstName: | CARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7010 W 145TH AVE | ||||||||
| Address2: | |||||||||
| City: | CEDAR LAKE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463039690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198955285 | ||||||||
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| Practice Location | |||||||||
| Address1: | 303 N HURSTBOURNE PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402225185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024125847 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2014 | ||||||||
| LastUpdateDate: | 07/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 160.005999 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 06004598A | IN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.