Provider Demographics
NPI:1639534118
Name:CHARITY, DEIDRA DEBNAM
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:DEBNAM
Last Name:CHARITY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEIDRA
Other - Middle Name:
Other - Last Name:DEBNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3042 BONDURANT HALL CB# 7135
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3708 MAYFAIR ST STE 110
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6223
Practice Address - Country:US
Practice Address - Phone:984-215-5090
Practice Address - Fax:984-215-5095
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist