Provider Demographics
NPI:1417264193
Name:DEBORAH K. DLABAL, PTPC
Entity Type:Organization
Organization Name:DEBORAH K. DLABAL, PTPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:DLABAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-299-8688
Mailing Address - Street 1:7609 NORTHRIDGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3011
Mailing Address - Country:US
Mailing Address - Phone:505-299-8688
Mailing Address - Fax:505-299-8688
Practice Address - Street 1:7609 NORTHRIDGE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3011
Practice Address - Country:US
Practice Address - Phone:505-299-8688
Practice Address - Fax:505-299-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM438251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77955731Medicaid