Provider Demographics
NPI:1801274717
Name:DEBAUCHE, SEUGNET (PT)
Entity type:Individual
Prefix:
First Name:SEUGNET
Middle Name:
Last Name:DEBAUCHE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SEUGNET
Other - Middle Name:
Other - Last Name:MULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:3200 SHORE DR
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4292
Practice Address - Country:US
Practice Address - Phone:715-732-8610
Practice Address - Fax:715-732-8650
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400223274Medicare Oscar/Certification
WIK400223273Medicare Oscar/Certification
WIK400223271Medicare Oscar/Certification