Provider Demographics
NPI:1720161482
Name:DOEBELE, DEBRA RAE (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:RAE
Last Name:DOEBELE
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 1:403 E 12TH ST
Mailing Address - Street 2:PO BOX 779
Mailing Address - City:SHAMROCK
Mailing Address - State:TX
Mailing Address - Zip Code:79079-1825
Mailing Address - Country:US
Mailing Address - Phone:806-256-2133
Mailing Address - Fax:806-256-1056
Practice Address - Street 1:403 E 12TH ST
Practice Address - Street 2:
Practice Address - City:SHAMROCK
Practice Address - State:TX
Practice Address - Zip Code:79079-1825
Practice Address - Country:US
Practice Address - Phone:806-256-2133
Practice Address - Fax:806-256-1056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650239Medicare ID - Type Unspecified