Provider Demographics
NPI:1912094657
Name:LEITER, DEBORAH LYN (RPT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LYN
Last Name:LEITER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8613 SW 80 COURT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7036
Mailing Address - Country:US
Mailing Address - Phone:305-662-2800
Mailing Address - Fax:305-668-3117
Practice Address - Street 1:6075 SW 72 STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5000
Practice Address - Country:US
Practice Address - Phone:305-662-2800
Practice Address - Fax:305-628-3117
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4810FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y8673Medicare ID - Type Unspecified