MEDICARE: DEBRA HAGEL-WOLLMAN PT

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	PT12083	CA

General Provider Information

NPI Number	:	1306058797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA HAGEL-WOLLMAN PT

Provider Business Mailing Address
First Line	:	4 WANDERLUST CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-7292
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 WANDERLUST CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-7292
Country	:	US
Telephone Number	:	818-399-4117
Fax Number	:

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

Provider Enumeration Date	:	05/05/2007
Last Update Date	:	03/11/2024

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