Provider Demographics
NPI:1134366750
Name:SPECHT, DEBRA K (LMT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:SPECHT
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 1:1 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4637
Mailing Address - Country:US
Mailing Address - Phone:503-551-0058
Mailing Address - Fax:941-460-0935
Practice Address - Street 1:579 S INDIANA AVE STE C
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3751
Practice Address - Country:US
Practice Address - Phone:941-681-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA86858225700000X
OR15766225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty