Provider Demographics
NPI:1508034257
Name:PERUTA, DEBORAH A (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:PERUTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:DASTYCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9 ELMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1401
Mailing Address - Country:US
Mailing Address - Phone:860-053-1204
Mailing Address - Fax:860-953-1208
Practice Address - Street 1:9 ELMWOOD CT
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1401
Practice Address - Country:US
Practice Address - Phone:860-953-1204
Practice Address - Fax:860-953-1208
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist