Provider Demographics
NPI:1992203574
Name:INABA, DEBORAH K (RCEP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:K
Last Name:INABA
Suffix:
Gender:F
Credentials:RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 S BRADDOCK ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3769
Mailing Address - Country:US
Mailing Address - Phone:540-771-0336
Mailing Address - Fax:
Practice Address - Street 1:1410 S BRADDOCK ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-771-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1008524224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist