Provider Demographics
NPI:1285779280
Name:MOURA, DEBORAH T (RPT)
Entity type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:T
Last Name:MOURA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 DOUGLAS AVE
Mailing Address - Street 2:SUITE 1029
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2593
Mailing Address - Country:US
Mailing Address - Phone:321-228-9050
Mailing Address - Fax:407-869-0821
Practice Address - Street 1:650 DOUGLAS AVE
Practice Address - Street 2:SUITE 1029
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2593
Practice Address - Country:US
Practice Address - Phone:321-228-9050
Practice Address - Fax:407-869-0821
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0826AMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID