Provider Demographics
NPI:1184676231
Name:BISACCIA, DEBRA MARIE (MSPT)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:MARIE
Last Name:BISACCIA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15803 SPARROWRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:27878
Mailing Address - Country:US
Mailing Address - Phone:914-844-8186
Mailing Address - Fax:
Practice Address - Street 1:#400 9787 CHARLOTTE HIGHWAY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707
Practice Address - Country:US
Practice Address - Phone:839-293-0007
Practice Address - Fax:839-293-0103
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12928225100000X
NY018539-12251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQD4751Medicare PIN
NYQD475Q45K1Medicare PIN