Provider Demographics
NPI:1841432218
Name:WALDEN, DEBRA ANN (PTA)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:WALDEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:WALDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:15160 N PEBBLE LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-2335
Mailing Address - Country:US
Mailing Address - Phone:239-267-2432
Mailing Address - Fax:
Practice Address - Street 1:15160 N PEBBLE LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-2335
Practice Address - Country:US
Practice Address - Phone:239-267-2432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19219225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant