MEDICARE: DEANA LEE GOLDSBY LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00013626	WA

General Provider Information

NPI Number	:	1689839375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANA LEE GOLDSBY LMP

Provider Business Mailing Address
First Line	:	2210 BLACK LAKE BLVD SW
Second Line	:	SUITE G
City	:	OLYMPIA
State	:	WA
Zip	:	98512
Country	:	US
Telephone Number	:	360-280-2585
Fax Number	:	360-352-5855

Provider Business Practice Location Address
First Line	:	2210 BLACK LAKE BLVD SW
Second Line	:	SUITE G
City	:	OLYMPIA
State	:	WA
Zip	:	98512
Country	:	US
Telephone Number	:	360-280-2585
Fax Number	:	360-352-5855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2008
Last Update Date	:	07/23/2008

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