Provider Demographics
NPI:1285889618
Name:DEBOE, LEE ANN NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LEE ANN
Middle Name:NICOLE
Last Name:DEBOE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 QUAIL BIRD PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2837
Mailing Address - Country:US
Mailing Address - Phone:616-218-4221
Mailing Address - Fax:
Practice Address - Street 1:524 QUAIL BIRD PL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2837
Practice Address - Country:US
Practice Address - Phone:616-218-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist