Provider Demographics
NPI:1184669038
Name:DWORACZYK, DEBRA M (PTA)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:M
Last Name:DWORACZYK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 RETAMA CIR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2765
Mailing Address - Country:US
Mailing Address - Phone:361-582-0611
Mailing Address - Fax:361-582-0555
Practice Address - Street 1:4206 RETAMA CIR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2765
Practice Address - Country:US
Practice Address - Phone:361-582-0611
Practice Address - Fax:361-582-0555
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2044667225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164704201Medicaid
TX454843Medicare Oscar/Certification