Provider Demographics
NPI:1043570583
Name:BIANCHET, DIANA FOGLE (LMT)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:FOGLE
Last Name:BIANCHET
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 1:3037 CLOVER BLOSSOM CIR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7985
Mailing Address - Country:US
Mailing Address - Phone:703-220-9864
Mailing Address - Fax:
Practice Address - Street 1:6322 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4105
Practice Address - Country:US
Practice Address - Phone:813-864-3998
Practice Address - Fax:813-864-3141
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 52905225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist