Provider Demographics
NPI:1437978509
Name:ROSEBROCK, DEBRA JANET (PTA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:JANET
Last Name:ROSEBROCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:JANET
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4000 STATE ROAD 45
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-8246
Mailing Address - Country:US
Mailing Address - Phone:317-796-2405
Mailing Address - Fax:
Practice Address - Street 1:103 WILLOW ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-7604
Practice Address - Country:US
Practice Address - Phone:812-988-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001776A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant