Provider Demographics
NPI:1265580583
Name:ROMINE, DEBORAH LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:ROMINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7720 E WOODLAND LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1688
Mailing Address - Country:US
Mailing Address - Phone:509-220-7871
Mailing Address - Fax:509-465-9198
Practice Address - Street 1:7720 E WOODLAND LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99212-1688
Practice Address - Country:US
Practice Address - Phone:509-220-7871
Practice Address - Fax:509-465-9198
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8337198Medicaid
WAGAB19960Medicare PIN