Provider Demographics
NPI:1689839375
Name:GOLDSBY, DEANA LEE (LMP)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:LEE
Last Name:GOLDSBY
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 1:2210 BLACK LAKE BLVD SW
Mailing Address - Street 2:SUITE G
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512
Mailing Address - Country:US
Mailing Address - Phone:360-280-2585
Mailing Address - Fax:360-352-5855
Practice Address - Street 1:2210 BLACK LAKE BLVD SW
Practice Address - Street 2:SUITE G
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512
Practice Address - Country:US
Practice Address - Phone:360-280-2585
Practice Address - Fax:360-352-5855
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013626225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist