MEDICARE: BARBARA DEGNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1120426	OTHER	TX	LICENSE #

General Provider Information

NPI Number	:	1659480861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA DEGNAN

Provider Business Mailing Address
First Line	:	10324 DURANGO TRL
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-8394
Country	:	US
Telephone Number	:	254-420-3895
Fax Number	:

Provider Business Practice Location Address
First Line	:	7003 WOODWAY DR
Second Line	:	STE 305
City	:	WACO
State	:	TX
Zip	:	76712-6170
Country	:	US
Telephone Number	:	254-776-7864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ BARBARA DEGNAN ” Practice Location

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