Provider Demographics
NPI:1366590994
Name:BALSER, DEBORAH LYNN (LMP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:BALSER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 DEER PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-8269
Mailing Address - Country:US
Mailing Address - Phone:360-452-8145
Mailing Address - Fax:
Practice Address - Street 1:1215 E 1ST ST STE E
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4323
Practice Address - Country:US
Practice Address - Phone:360-452-8145
Practice Address - Fax:360-452-8145
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009632225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist