Provider Demographics
NPI:1013091321
Name:JARZOMKOWSKI, DEBRA RENEE (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:RENEE
Last Name:JARZOMKOWSKI
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 1:185 MADISON PL
Mailing Address - Street 2:XXX
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1371
Mailing Address - Country:US
Mailing Address - Phone:770-460-6469
Mailing Address - Fax:
Practice Address - Street 1:1701 HARDEE AVENUE SW
Practice Address - Street 2:
Practice Address - City:FORT MCPHERSON
Practice Address - State:GA
Practice Address - Zip Code:30330-1062
Practice Address - Country:US
Practice Address - Phone:404-464-3765
Practice Address - Fax:404-464-3928
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT1518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist