Provider Demographics
NPI:1437493988
Name:PRUDHOMME, DEBORAH (PTA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PRUDHOMME
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 1:9850 ROSEBLOOM AVE
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9044
Mailing Address - Country:US
Mailing Address - Phone:831-246-1176
Mailing Address - Fax:
Practice Address - Street 1:20400 SARATOGA LOS GATOS RD
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5927
Practice Address - Country:US
Practice Address - Phone:408-741-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9888225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant