Provider Demographics
NPI:1891163556
Name:GISKE, DEBRA (LMP, CDT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:GISKE
Suffix:
Gender:F
Credentials:LMP, CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1012
Mailing Address - Country:US
Mailing Address - Phone:253-209-5851
Mailing Address - Fax:
Practice Address - Street 1:2705 LOCUST AVE W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-3408
Practice Address - Country:US
Practice Address - Phone:253-209-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012053225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist