Healthcare Provider Details

I. General information

NPI: 1720161482
Provider Name (Legal Business Name): DEBRA RAE DOEBELE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 12TH ST
SHAMROCK TX
79079-1825
US

IV. Provider business mailing address

403 E 12TH ST PO BOX 779
SHAMROCK TX
79079-1825
US

V. Phone/Fax

Practice location:
  • Phone: 806-256-2133
  • Fax: 806-256-1056
Mailing address:
  • Phone: 806-256-2133
  • Fax: 806-256-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1015923
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: