Provider Demographics
NPI:1598983207
Name:SERGENT, DEBORAH FRANCIS (LMP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:FRANCIS
Last Name:SERGENT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9126 MULLEN RD SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-4751
Mailing Address - Country:US
Mailing Address - Phone:360-491-9548
Mailing Address - Fax:
Practice Address - Street 1:1001 EASTSIDE ST SE
Practice Address - Street 2:SUITE C
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1608
Practice Address - Country:US
Practice Address - Phone:369-705-9758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012789225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist