Provider Demographics
NPI:1588004089
Name:BASTIDA, DEANNA MARIE
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:MARIE
Last Name:BASTIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N BAKER AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4469
Mailing Address - Country:US
Mailing Address - Phone:509-393-9871
Mailing Address - Fax:
Practice Address - Street 1:601 N BAKER AVE APT 109
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-4469
Practice Address - Country:US
Practice Address - Phone:509-393-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60265062172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist