Provider Demographics
NPI:1346361862
Name:WEMPLE, DEBORAH BRUGH (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:BRUGH
Last Name:WEMPLE
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:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170-0645
Mailing Address - Country:US
Mailing Address - Phone:386-428-0723
Mailing Address - Fax:386-428-0723
Practice Address - Street 1:120 FAULKNER ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7018
Practice Address - Country:US
Practice Address - Phone:386-428-0723
Practice Address - Fax:386-428-0723
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA7990225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689214196Medicaid
FLC5173OtherBLUECROSS BLUESHIELD