Provider Demographics
NPI:1700910924
Name:HARRIOTT, DEBORAH JEAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEAN
Last Name:HARRIOTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 131ST WAY
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3115
Mailing Address - Country:US
Mailing Address - Phone:727-399-8578
Mailing Address - Fax:
Practice Address - Street 1:2104 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2323
Practice Address - Country:US
Practice Address - Phone:727-587-0582
Practice Address - Fax:727-587-0583
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 531225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant