Provider Demographics
NPI:1639867328
Name:SMITH, DEBARA MARIE
Entity Type:Individual
Prefix:MS
First Name:DEBARA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBARA
Other - Middle Name:MARIE
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11833 TRAIL SKY CT
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3039
Mailing Address - Country:US
Mailing Address - Phone:951-440-5206
Mailing Address - Fax:
Practice Address - Street 1:11833 TRAIL SKY CT
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3039
Practice Address - Country:US
Practice Address - Phone:951-440-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.015271225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant