Healthcare Provider Details

I. General information

NPI: 1013102375
Provider Name (Legal Business Name): DEBRA A. GEBHARD L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 SW G ST 2ND FLOOR
GRANTS PASS OR
97526-2413
US

IV. Provider business mailing address

PO BOX 23
WOLF CREEK OR
97497-0023
US

V. Phone/Fax

Practice location:
  • Phone: 541-660-8988
  • Fax:
Mailing address:
  • Phone: 541-660-8988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5829
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: