Provider Demographics
NPI:1174893200
Name:IRELAND, DEBORAH ANN (PT ASSISTANT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:IRELAND
Suffix:
Gender:F
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10948 MARKLEIN AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1328
Mailing Address - Country:US
Mailing Address - Phone:818-359-8145
Mailing Address - Fax:
Practice Address - Street 1:10948 MARKLEIN AVE
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1328
Practice Address - Country:US
Practice Address - Phone:818-359-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT339225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant