Provider Demographics
NPI:1215919790
Name:SIX, DEBORAH A (PT)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:A
Last Name:SIX
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 1:94 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1340
Mailing Address - Country:US
Mailing Address - Phone:207-839-5860
Mailing Address - Fax:207-839-2499
Practice Address - Street 1:335 CORINNA RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-2040
Practice Address - Country:US
Practice Address - Phone:207-992-4042
Practice Address - Fax:207-992-4043
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME731225100000X
MEPT731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432640299Medicaid
ME432640299Medicaid
ME1315Medicare PIN