MEDICARE: DEBRA KOMINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA23510	FL

General Provider Information

NPI Number	:	1508311911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA KOMINS

Provider Business Mailing Address
First Line	:	124 MARINERS DR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-2343
Country	:	US
Telephone Number	:	386-299-2386
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 MARINERS DR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-2343
Country	:	US
Telephone Number	:	386-299-2386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	09/05/2023

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Directions to “ DEBRA KOMINS ” Practice Location

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