Provider Demographics
NPI:1164692422
Name:BRANDAL, DEBORAH J (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:BRANDAL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4373 PARADISE PL
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-8427
Mailing Address - Country:US
Mailing Address - Phone:206-335-2754
Mailing Address - Fax:360-799-8880
Practice Address - Street 1:4373 PARADISE PL
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8427
Practice Address - Country:US
Practice Address - Phone:206-335-2754
Practice Address - Fax:360-799-8880
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020231225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist