Provider Demographics
NPI:1558775726
Name:TOMPKINS, DEBRA (PTA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:TOMPKINS
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 1:5570 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5477
Mailing Address - Country:US
Mailing Address - Phone:716-250-4137
Mailing Address - Fax:
Practice Address - Street 1:5570 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5477
Practice Address - Country:US
Practice Address - Phone:716-250-4137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009175-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant