Provider Demographics
NPI:1073717971
Name:GIROD, DIANE FAYE (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:FAYE
Last Name:GIROD
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 DAYTON AVE
Mailing Address - Street 2:# 3
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6277
Mailing Address - Country:US
Mailing Address - Phone:651-631-1751
Mailing Address - Fax:651-631-1751
Practice Address - Street 1:1635 DAYTON AVE
Practice Address - Street 2:# 3
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6277
Practice Address - Country:US
Practice Address - Phone:651-631-1751
Practice Address - Fax:651-631-1751
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2881635OtherMN CARE STATE TAX ID