Provider Demographics
NPI:1104958917
Name:PURCELL, DEBORAH (PT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3505
Mailing Address - Country:US
Mailing Address - Phone:732-583-3144
Mailing Address - Fax:
Practice Address - Street 1:100 CAMPUS DR STE 102
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1253
Practice Address - Country:US
Practice Address - Phone:732-591-9494
Practice Address - Fax:732-591-8850
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA04085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ061461N11Medicare ID - Type Unspecified