Provider Demographics
NPI:1205157344
Name:DERUSHA, ESTHER WALBERG (LMP)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:WALBERG
Last Name:DERUSHA
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:P.O. BOX 657
Mailing Address - Street 2:8 COULEE BLVD.
Mailing Address - City:ELECTRIC CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99123
Mailing Address - Country:US
Mailing Address - Phone:509-633-0777
Mailing Address - Fax:
Practice Address - Street 1:8 COULEE BLVD.
Practice Address - Street 2:
Practice Address - City:ELECTRIC CITY
Practice Address - State:WA
Practice Address - Zip Code:99123
Practice Address - Country:US
Practice Address - Phone:509-633-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005237225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist