Basic Information
| Provider Information | |||||||||
| NPI: | 1538259882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEBOER | ||||||||
| FirstName: | DEVIN | ||||||||
| MiddleName: | PETER | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 CENTRAL AVENUE | ||||||||
| Address2: | |||||||||
| City: | ZEELAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167720936 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3491 LINCOLN RD | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494199512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2697512150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501008416 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.