MEDICARE: MS. DEBORAH HARTOG PHYSICAL THERAPIST

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

General Provider Information

NPI Number	:	1821142340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH HARTOG PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	1579 SANCHEZ ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-2329
Country	:	US
Telephone Number	:	415-821-4148
Fax Number	:	415-821-4004

Provider Business Practice Location Address
First Line	:	1579 SANCHEZ ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-2329
Country	:	US
Telephone Number	:	415-821-4148
Fax Number	:	415-821-4004

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	09/20/2016

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