Debora Jean Prendergast, PTA
Individual provider Active NPI Physical Therapy Assistant · Minerva, OH
NPI 1619174547 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619174547
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- PTA03600 (OH)
- Practice address
- 400 Carolyn CT
Minerva, OH 44657-8703 - Phone
- (330) 868-4104
- Fax
- (330) 868-7714
- NPI assigned
- Jul 3, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA03600 | OH | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA03600 | OH | Yes |
Addresses
Primary practice location
400 Carolyn CT
Minerva, OH 44657-8703
Mailing address
7995 Knox School Rd
Minerva, OH 44657-9437
Phone (330) 894-2894
Other providers in Minerva, OH
- Perry M Lieberman OD
- Kelly Plottner
- Amanda Preas
- Premier Health Associates Inc
- Angela M Prendergast
- Michael Pribula
- Quest Recovery and Prevention Services, Inc.
- Rath Optometry LLC
- Ted A Rath
- Reaach, LLC
All providers in Minerva, OH · Physical Therapy Assistant in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.