Provider Demographics
NPI:1841263530
Name:SIMONETTI, DEBORAH MAY (PT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MAY
Last Name:SIMONETTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4044 15TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6962
Mailing Address - Country:US
Mailing Address - Phone:360-456-5154
Mailing Address - Fax:360-456-0844
Practice Address - Street 1:4044 15TH AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6962
Practice Address - Country:US
Practice Address - Phone:360-456-5154
Practice Address - Fax:360-456-0844
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB09639Medicare UPIN