Provider Demographics
NPI:1184783656
Name:PERRON, DEBRA MICHELE (PTA)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MICHELE
Last Name:PERRON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:MICHELE
Other - Last Name:CORNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:27 BARBARA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4301
Mailing Address - Country:US
Mailing Address - Phone:631-981-7338
Mailing Address - Fax:
Practice Address - Street 1:159 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2205
Practice Address - Country:US
Practice Address - Phone:631-543-4500
Practice Address - Fax:631-543-5162
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001694225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant