Healthcare Provider Details

I. General information

NPI: 1013091321
Provider Name (Legal Business Name): DEBRA RENEE JARZOMKOWSKI P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 HARDEE AVENUE SW
FORT MCPHERSON GA
30330-1062
US

IV. Provider business mailing address

185 MADISON PL XXX
FAYETTEVILLE GA
30214-1371
US

V. Phone/Fax

Practice location:
  • Phone: 404-464-3765
  • Fax: 404-464-3928
Mailing address:
  • Phone: 770-460-6469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1518
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: