Individual
SHARILYNN R DEBOER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
6625 W LINCOLN HWY, CROWN POINT, IN 46307-9678
(219) 440-5360
Mailing address
680 N LAKE SHORE DR, SUITE 830, CHICAGO, IL 60611-4546
(312) 943-7850
(312) 943-0057
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05013218A
IN
225100000X
Physical Therapist
070015010
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619908
BCBS IL GROUP NUMBER
IL
01
—
1623066
BCBS PROVIDER NUMBER
IL
01
—
367885100
US DEPT OF LABOR
IL
01
—
568150
MEDICARE GROUP NUMBER
IL
Enumeration date
06/01/2006
Last updated
10/18/2019
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