Provider Demographics
NPI:1215008966
Name:HALLENBAKE, DEBRA (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:HALLENBAKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 SR 64 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212
Mailing Address - Country:US
Mailing Address - Phone:941-792-1404
Mailing Address - Fax:941-795-1717
Practice Address - Street 1:8000 SR 64 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:941-795-1717
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD690ZMedicare PIN