Provider Demographics
NPI:1487010443
Name:THURSBY, DEVON KYLE
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:KYLE
Last Name:THURSBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 CALIFORNIA AVE SW #3D
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136
Mailing Address - Country:US
Mailing Address - Phone:850-559-2399
Mailing Address - Fax:
Practice Address - Street 1:6307 CALIFORNIA AVE SW #3D
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136
Practice Address - Country:US
Practice Address - Phone:850-559-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60582401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist