Provider Demographics
NPI:1255317855
Name:VIRTANEN, DEBRA Q (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:Q
Last Name:VIRTANEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FEDERAL ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2832
Mailing Address - Country:US
Mailing Address - Phone:518-272-3324
Mailing Address - Fax:518-274-6904
Practice Address - Street 1:500 FEDERAL ST
Practice Address - Street 2:SUITE 302
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2832
Practice Address - Country:US
Practice Address - Phone:518-272-3324
Practice Address - Fax:518-274-6904
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ56921OtherEMPIRE BC
NY000405280001OtherBLUE SHIELD
NY005954OtherLICENSE
NY43153OtherMVP
NY10002115OtherCDPHP
NY43153OtherMVP