Provider Demographics
NPI:1720389612
Name:WILLIAMSON, DEBRA SUE (CPTA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:KS
Mailing Address - Zip Code:67356-2326
Mailing Address - Country:US
Mailing Address - Phone:620-795-8960
Mailing Address - Fax:
Practice Address - Street 1:1217 S 15TH ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-5125
Practice Address - Country:US
Practice Address - Phone:620-421-2431
Practice Address - Fax:620-423-0158
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02085225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant