Provider Demographics
NPI:1194799189
Name:THRALL, DEBORAH C (MDT CERT PT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:C
Last Name:THRALL
Suffix:
Gender:F
Credentials:MDT CERT PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 GARDEN ST
Mailing Address - Street 2:103
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3278
Mailing Address - Country:US
Mailing Address - Phone:503-723-0347
Mailing Address - Fax:503-655-9305
Practice Address - Street 1:1554 GARDEN ST
Practice Address - Street 2:103
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3278
Practice Address - Country:US
Practice Address - Phone:503-723-0347
Practice Address - Fax:503-655-9305
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR141196Medicare UPIN