Healthcare Provider Details

I. General information

NPI: 1518185586
Provider Name (Legal Business Name): DEBRA ANN THIRION MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA THIRION MCCLELLAN PT

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 GENETIC CENTER DR
SAN DIEGO CA
92121-6310
US

IV. Provider business mailing address

5651 COPLEY DR
SAN DIEGO CA
92111-7903
US

V. Phone/Fax

Practice location:
  • Phone: 858-526-6180
  • Fax:
Mailing address:
  • Phone: 858-262-6344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number26778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: