Active NPI
Philip Carl Debruin, MPT
- Physical Therapist
- Rome, NY
National Provider Identifier
1225110653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 021618
- Practice address
- 125 Buckley Rd
Donald J. Mitchell VA Clinic
Rome, NY 13440 - Phone
- (315) 334-7120
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 021618 | NY | Primary |
Addresses
Primary practice location
125 Buckley Rd
Donald J. Mitchell VA Clinic
Rome, NY 13440
Mailing address
125 Buckley Rd
Donald J. Mitchell VA Clinic
Rome, NY 13440
Phone (315) 334-7120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021618 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225110653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 BUCKLEY RD",
"address_2": "DONALD J. MITCHELL VA CLINIC",
"city": "ROME",
"state": "NY",
"postal_code": "13440",
"telephone_number": "315-334-7120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 BUCKLEY RD",
"address_2": "DONALD J. MITCHELL VA CLINIC",
"city": "ROME",
"state": "NY",
"postal_code": "13440",
"telephone_number": "315-334-7120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBRUIN",
"first_name": "PHILIP",
"middle_name": "CARL",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "021618",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rome, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.