Provider Demographics
NPI:1265407332
Name:IBORG, DEBORAH (ATC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:IBORG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CHANDLER CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5340
Mailing Address - Country:US
Mailing Address - Phone:314-513-4285
Mailing Address - Fax:
Practice Address - Street 1:3400 PERSHALL RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63135-1408
Practice Address - Country:US
Practice Address - Phone:314-513-4285
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00047390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program