Provider Demographics
NPI:1831370097
Name:EASTMAN, DEBRA JANE (LMT)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JANE
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DEJA
Other - Middle Name:
Other - Last Name:EASTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3855
Mailing Address - Street 2:
Mailing Address - City:ABQ
Mailing Address - State:NM
Mailing Address - Zip Code:87190-3855
Mailing Address - Country:US
Mailing Address - Phone:505-830-4588
Mailing Address - Fax:505-830-2946
Practice Address - Street 1:2539 MORNINGSIDE DR NE
Practice Address - Street 2:
Practice Address - City:ABQ
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-830-4588
Practice Address - Fax:505-830-2946
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1449225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist