Active NPI
Debra M Iacono, PT
- Physical Therapist
- Cayce, SC
National Provider Identifier
1982753091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1915
- Practice address
- 3799 12TH Street Ext Ste 100
Cayce, SC 29033-3750 - Phone
- (803) 926-6810
- Fax
- (803) 926-6811
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- 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 | 1915 | SC | Primary |
Addresses
Primary practice location
3799 12TH Street Ext Ste 100
Cayce, SC 29033-3750
Mailing address
PO Box 896239
Charlotte, NC 28289-6239
Phone (803) 926-6810
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1915 | Other | SC | LICENSE # |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1915 | SC | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537401600000",
"number": "1982753091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 896239",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282896239",
"telephone_number": "803-926-6810",
"fax_number": "803-926-6811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3799 12TH STREET EXT STE 100",
"city": "CAYCE",
"state": "SC",
"postal_code": "290333750",
"telephone_number": "803-926-6810",
"fax_number": "803-926-6811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IACONO",
"first_name": "DEBRA",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2018-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "1915",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "1915",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cayce, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.