Provider Demographics
NPI:1588800395
Name:CORCIMIGLIA, DEBRA J R (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:J R
Last Name:CORCIMIGLIA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1218
Mailing Address - Country:US
Mailing Address - Phone:716-560-9884
Mailing Address - Fax:716-592-3559
Practice Address - Street 1:243 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1089
Practice Address - Country:US
Practice Address - Phone:716-560-9884
Practice Address - Fax:716-592-3559
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008843-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist