MEDICARE: MS. DEBRA RENEE JARZOMKOWSKI P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT1518	KY

General Provider Information

NPI Number	:	1013091321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA RENEE JARZOMKOWSKI P.T.

Provider Business Mailing Address
First Line	:	185 MADISON PL
Second Line	:	XXX
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-1371
Country	:	US
Telephone Number	:	770-460-6469
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 HARDEE AVENUE SW
Second Line	:
City	:	FORT MCPHERSON
State	:	GA
Zip	:	30330-1062
Country	:	US
Telephone Number	:	404-464-3765
Fax Number	:	404-464-3928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/21/2022

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