Provider Demographics
NPI:1700093572
Name:KROGGEL, DEBORAH KATHERINE (PTA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KATHERINE
Last Name:KROGGEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9917 GABLE RIDGE TER
Mailing Address - Street 2:APT. # G
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4648
Mailing Address - Country:US
Mailing Address - Phone:301-977-4072
Mailing Address - Fax:301-598-7432
Practice Address - Street 1:3836 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1548
Practice Address - Country:US
Practice Address - Phone:301-598-7420
Practice Address - Fax:301-598-7432
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2940225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant