Provider Demographics
NPI:1558639500
Name:TOM, DEBORAH T (MSPT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:T
Last Name:TOM
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 AULEPE ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4161
Mailing Address - Country:US
Mailing Address - Phone:808-258-0902
Mailing Address - Fax:
Practice Address - Street 1:1343 AULEPE ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4161
Practice Address - Country:US
Practice Address - Phone:808-258-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT7472251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics