Healthcare Provider Details

I. General information

NPI: 1215437637
Provider Name (Legal Business Name): DEBORA MAE BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 LASKIN RD
VIRGINIA BEACH VA
23451-6007
US

IV. Provider business mailing address

4404 WAKEFIELD DR
VIRGINIA BEACH VA
23455-4460
US

V. Phone/Fax

Practice location:
  • Phone: 757-263-2800
  • Fax:
Mailing address:
  • Phone: 757-510-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305004184
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: