Provider Demographics
NPI:1063652493
Name:GEIGER, DIANE LEE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LEE
Last Name:GEIGER
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 1:1010 W ROBERT BUSH DRIVE
Mailing Address - Street 2:P O BOX 211
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586
Mailing Address - Country:US
Mailing Address - Phone:360-875-5543
Mailing Address - Fax:360-875-5544
Practice Address - Street 1:1010 W ROBERT BUSH DR
Practice Address - Street 2:BOX 211
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586
Practice Address - Country:US
Practice Address - Phone:360-875-5543
Practice Address - Fax:360-875-5544
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist