Provider Demographics
NPI:1770951766
Name:VAAGEN, DEBRA (PTA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:VAAGEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 RAYJAY CIR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:ND
Mailing Address - Zip Code:58656-7130
Mailing Address - Country:US
Mailing Address - Phone:701-974-3736
Mailing Address - Fax:
Practice Address - Street 1:306 RAYJAY CIR
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:ND
Practice Address - Zip Code:58656-7130
Practice Address - Country:US
Practice Address - Phone:218-434-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND225200000X225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant