Provider Demographics
NPI:1619372539
Name:MERCURIO, DEBORAH LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3620 HARLEM RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2042
Mailing Address - Country:US
Mailing Address - Phone:716-446-9500
Mailing Address - Fax:716-446-9501
Practice Address - Street 1:3620 HARLEM RD
Practice Address - Street 2:STE 2
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14215-2042
Practice Address - Country:US
Practice Address - Phone:716-446-9500
Practice Address - Fax:716-446-9501
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011064-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist