Basic Information
| Provider Information | |||||||||
| NPI: | 1275632978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARK | ||||||||
| FirstName: | DEBBIE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DILLOW | ||||||||
| OtherFirstName: | DEBBIE | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 342 VIRGINIA AVENUE | ||||||||
| Address2: | HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC | ||||||||
| City: | WYTHEVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762286200 | ||||||||
| FaxNumber: | 2762289175 | ||||||||
| Practice Location | |||||||||
| Address1: | 342 VIRGINIA AVENUE | ||||||||
| Address2: | HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC | ||||||||
| City: | WYTHEVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762286200 | ||||||||
| FaxNumber: | 2762289175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305001898 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.