Provider Demographics
NPI:1457655383
Name:GOULD, DEBBRA GAYE (LMT, MMT)
Entity Type:Individual
Prefix:
First Name:DEBBRA
Middle Name:GAYE
Last Name:GOULD
Suffix:
Gender:F
Credentials:LMT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 284TH ST E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-6994
Mailing Address - Country:US
Mailing Address - Phone:253-722-6136
Mailing Address - Fax:253-210-4521
Practice Address - Street 1:14201 284TH ST E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-6994
Practice Address - Country:US
Practice Address - Phone:253-722-6136
Practice Address - Fax:253-210-4521
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010263172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist