Provider Demographics
NPI:1013539923
Name:INMAN, DEBORAH LEANN (LMT, KTP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEANN
Last Name:INMAN
Suffix:
Gender:F
Credentials:LMT, KTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22768 STATE HIGHWAY 39 STE B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-5283
Mailing Address - Country:US
Mailing Address - Phone:417-440-0401
Mailing Address - Fax:
Practice Address - Street 1:22768 STATE HIGHWAY 39 STE B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-5283
Practice Address - Country:US
Practice Address - Phone:417-440-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009000045225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009000045OtherMISSOURI MASSAGE THERAPIST LICENSE
MO2013007195OtherMISSOURI MASSAGE THERAPY BUSINESS LICENSE