Provider Demographics
NPI:1710584354
Name:DEFREITAS, DEBORAH ANGIE (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANGIE
Last Name:DEFREITAS
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 1:1405 SUTTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4003
Mailing Address - Country:US
Mailing Address - Phone:347-338-8916
Mailing Address - Fax:
Practice Address - Street 1:1405 SUTTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4003
Practice Address - Country:US
Practice Address - Phone:347-338-8916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031894-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist