Provider Demographics
NPI:1154583912
Name:DALLETT, DEBRA ANNE (PT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANNE
Last Name:DALLETT
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 1:134 MADISON AVE S
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1224
Mailing Address - Country:US
Mailing Address - Phone:609-561-1533
Mailing Address - Fax:609-567-2458
Practice Address - Street 1:134 MADISON AVE S
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1224
Practice Address - Country:US
Practice Address - Phone:609-561-1533
Practice Address - Fax:609-567-2458
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00510700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist