Healthcare Provider Details

I. General information

NPI: 1427276336
Provider Name (Legal Business Name): DEBORAH WINNE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR1 RTE 32 SO
GREENVILLE NY
12083
US

IV. Provider business mailing address

PO BOX 103
RENSSELAER NY
12144-0103
US

V. Phone/Fax

Practice location:
  • Phone: 518-966-4568
  • Fax: 518-966-4569
Mailing address:
  • Phone: 518-479-0024
  • Fax: 518-479-0962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0028561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: