Provider Demographics
NPI:1932200284
Name:HAM, DEBORAH SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SUE
Last Name:HAM
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 1:4415 S HELENA ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4312
Mailing Address - Country:US
Mailing Address - Phone:509-448-6399
Mailing Address - Fax:
Practice Address - Street 1:3151 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4800
Practice Address - Country:US
Practice Address - Phone:509-532-0500
Practice Address - Fax:509-532-8810
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0189666OtherDEPT OF LABOR & INDUSTRY
4531917OtherAETNA
8851615Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE