Individual
KATHI ELLISON DEBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1555 DOUSMAN ST, GREEN BAY, WI 54303-3207
(920) 494-4525
(920) 494-6887
Mailing address
1555 DOUSMAN ST, GREEN BAY, WI 54303-3207
(920) 494-4525
(920) 494-6887
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36137800
—
WI
Enumeration date
04/04/2008
Last updated
04/04/2008
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