Provider Demographics
NPI:1578967543
Name:RAY, DEANA MARIE (LMP, CMA)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:MARIE
Last Name:RAY
Suffix:
Gender:F
Credentials:LMP, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18215 N RANCHETTE RD
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9633
Mailing Address - Country:US
Mailing Address - Phone:509-954-5256
Mailing Address - Fax:
Practice Address - Street 1:1231 N DIVISION, STE 105
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218
Practice Address - Country:US
Practice Address - Phone:509-466-1117
Practice Address - Fax:509-464-0578
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60163278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist