Provider Demographics
NPI:1154301497
Name:HAEGEL, DEBRA OWENS (RPT)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:OWENS
Last Name:HAEGEL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2224
Mailing Address - Country:US
Mailing Address - Phone:510-533-3280
Mailing Address - Fax:510-533-3285
Practice Address - Street 1:3022 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2224
Practice Address - Country:US
Practice Address - Phone:510-533-3280
Practice Address - Fax:510-533-3285
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT93750Medicare ID - Type UnspecifiedPROVIDER ID NUMBER