Provider Demographics
NPI:1629684519
Name:ABDULLAH, DEON (LMT)
Entity Type:Individual
Prefix:MR
First Name:DEON
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 S SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-2304
Mailing Address - Country:US
Mailing Address - Phone:206-775-0498
Mailing Address - Fax:
Practice Address - Street 1:5820 S SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-2304
Practice Address - Country:US
Practice Address - Phone:206-775-0498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61102744225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist