Provider Demographics
NPI:1760583744
Name:DEAGLE, ROBERT FRANCIS (MPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:FRANCIS
Last Name:DEAGLE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 CRAZY HORSE ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682
Mailing Address - Country:US
Mailing Address - Phone:530-672-6492
Mailing Address - Fax:
Practice Address - Street 1:1004 FOWLER WAY
Practice Address - Street 2:# 9
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-626-4734
Practice Address - Fax:530-626-6551
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist