Provider Demographics
NPI:1578582789
Name:DEBRA Q. VIRTANEN
Entity Type:Organization
Organization Name:DEBRA Q. VIRTANEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:VIRTANEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:518-272-3324
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005954-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000405280001OtherBS
NY01097176Medicaid
NY5306322OtherAETNA
NY00040402301OtherUNIVERA
NY10002115OtherCDPHP
NY43153OtherMVP
NYQ56921OtherEMPIRE BC
NY000405280001OtherBS