Healthcare Provider Details

I. General information

NPI: 1831733138
Provider Name (Legal Business Name): DEBORAH ANN GILSTRAP LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 LECLERC RD N STE 1
CUSICK WA
99119-5015
US

IV. Provider business mailing address

PO BOX 39
USK WA
99180-0039
US

V. Phone/Fax

Practice location:
  • Phone: 509-445-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number00006922
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: