Provider Demographics
NPI:1093060618
Name:BERKEY, DIANE J (LMP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:BERKEY
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 1:190 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7664
Mailing Address - Country:US
Mailing Address - Phone:509-366-8689
Mailing Address - Fax:
Practice Address - Street 1:134 KEENE RD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8683
Practice Address - Country:US
Practice Address - Phone:509-628-9966
Practice Address - Fax:509-628-9976
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60297544225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist