Provider Demographics
NPI:1831495605
Name:JANICK, DEBORAH GERALYN (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:GERALYN
Last Name:JANICK
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 1:455 BRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-2642
Mailing Address - Country:US
Mailing Address - Phone:508-679-2240
Mailing Address - Fax:508-679-2983
Practice Address - Street 1:455 BRAYTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-2642
Practice Address - Country:US
Practice Address - Phone:508-679-2240
Practice Address - Fax:508-679-2983
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00506225100000X
MA53982251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist