Healthcare Provider Details

I. General information

NPI: 1962468496
Provider Name (Legal Business Name): DEBRA MARIE COMBS M.S.ED, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARRISH ST
CANANDAIGUA NY
14424-1731
US

IV. Provider business mailing address

1358 HAMMOND RD
PALMYRA NY
14522-9720
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-6700
  • Fax:
Mailing address:
  • Phone: 585-396-0963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000181-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: