Provider Demographics
NPI:1598710741
Name:DEPTO, DEBRA (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:DEPTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PERDIDO KEY CT
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-0545
Mailing Address - Country:US
Mailing Address - Phone:904-217-3951
Mailing Address - Fax:
Practice Address - Street 1:60 PERDIDO KEY CT
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-0545
Practice Address - Country:US
Practice Address - Phone:904-217-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010243225100000X
FLPT254922251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02683750Medicaid
NY02683750Medicaid
NYQ54315Medicare UPIN