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General NPI Number Information
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NPI Number | 1891163556
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Entity Type | Individual
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Provider Name | DEBRA GISKE LMP, CDT
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Gender | Female
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 2705 LOCUST AVE W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-3408
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Country | US
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Telephone | 253-209-5851
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Fax |
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Provider Business Mailing Address
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Address Line | 8425 S 17TH ST
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City | TACOMA
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State | WA
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Zip | 98465-1012
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Country | US
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Telephone | 253-209-5851
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00012053
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License Number State | WA
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