Provider Demographics
NPI:1881815512
Name:SIMMONS, DEBORA (LMP)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:SIMMONS
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 1:919 128TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6315
Mailing Address - Country:US
Mailing Address - Phone:425-347-8614
Mailing Address - Fax:425-348-6986
Practice Address - Street 1:919 128TH ST SW
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6315
Practice Address - Country:US
Practice Address - Phone:425-347-8614
Practice Address - Fax:425-348-6986
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA21321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA200181386OtherTAX ID