Provider Demographics
NPI:1811521057
Name:FROMER, DEBRA DANIELLE (LMT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:DANIELLE
Last Name:FROMER
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MORPER
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015
Mailing Address - Country:US
Mailing Address - Phone:505-307-3924
Mailing Address - Fax:
Practice Address - Street 1:2 MARIETTA CT STE C
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-9400
Practice Address - Country:US
Practice Address - Phone:505-307-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT9332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist