Healthcare Provider Details

I. General information

NPI: 1184676231
Provider Name (Legal Business Name): DEBRA BISACCIA MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date: 07/17/2026
Reactivation Date: 08/17/2026

III. Provider practice location address

105 BEN CASEY DR STE 127
FORT MILL SC
29708-8557
US

IV. Provider business mailing address

15803 SPARROWRIDGE CT
CHARLOTTE NC
27878
US

V. Phone/Fax

Practice location:
  • Phone: 803-802-5855
  • Fax: 803-802-5855
Mailing address:
  • Phone: 914-844-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number018539-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018539-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12928
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: