Active NPI
Deborah Lynn Wallace-Ducharme, L.P.T.
- Physical Therapist
- Ithaca, NY
National Provider Identifier
1902233901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 006493-1
- Practice address
- 1001 W Seneca St
Ithaca, NY 14850-3342 - Phone
- (607) 277-8020
- NPI assigned
- Oct 4, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 | 006493-1 | NY | Primary |
Addresses
Primary practice location
1001 W Seneca St
Ithaca, NY 14850-3342
Mailing address
30 Lake Shore Rd
Lansing, NY 14882-9029
Phone (607) 227-5335
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 |
|---|---|---|---|
| 006493-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380844800000",
"number": "1902233901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 LAKE SHORE RD",
"city": "LANSING",
"state": "NY",
"postal_code": "148829029",
"telephone_number": "607-227-5335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 W SENECA ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "148503342",
"telephone_number": "607-277-8020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE-DUCHARME",
"first_name": "DEBORAH",
"middle_name": "LYNN",
"credential": "L.P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-10-04",
"last_updated": "2013-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "006493-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.