Provider Demographics
NPI:1326216441
Name:NEUNDORFER, DEBBIE DIANE (PT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:DIANE
Last Name:NEUNDORFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:DIANE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-810-0054
Practice Address - Street 1:1651 W. ROSEDALE, SUITE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7437
Practice Address - Country:US
Practice Address - Phone:817-810-0001
Practice Address - Fax:817-810-0054
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1188481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213118702Medicaid