Healthcare Provider Details

I. General information

NPI: 1255350195
Provider Name (Legal Business Name): DEBORAH DAIMARU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 FOXBORO DR
NEWPORT NEWS VA
23602-8905
US

IV. Provider business mailing address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0002
US

V. Phone/Fax

Practice location:
  • Phone: 757-810-7355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: