Provider Demographics
NPI:1033362728
Name:DESTEFANIS, DEBORAH ANNE (LMT, PTA, CPFT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANNE
Last Name:DESTEFANIS
Suffix:
Gender:F
Credentials:LMT, PTA, CPFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 GENESEE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4727
Mailing Address - Country:US
Mailing Address - Phone:315-269-4047
Mailing Address - Fax:
Practice Address - Street 1:1402 GENESEE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4727
Practice Address - Country:US
Practice Address - Phone:315-269-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012206172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist