Provider Demographics
NPI:1003113481
Name:DIERINGER, BARBARA SUSAN (LMT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:SUSAN
Last Name:DIERINGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13136 SW RAPTOR PL
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2872
Mailing Address - Country:US
Mailing Address - Phone:503-939-5800
Mailing Address - Fax:
Practice Address - Street 1:13136 SW RAPTOR PL
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2872
Practice Address - Country:US
Practice Address - Phone:503-939-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-19
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
OR6098225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer