Provider Demographics
NPI:1013102375
Name:GEBHARD, DEBRA A (LMT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:GEBHARD
Suffix:
Gender:F
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:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:WOLF CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97497-0023
Mailing Address - Country:US
Mailing Address - Phone:541-660-8988
Mailing Address - Fax:
Practice Address - Street 1:141 SW G ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2413
Practice Address - Country:US
Practice Address - Phone:541-660-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist