Provider Demographics
NPI:1093349466
Name:PRIESTMAN, DIANA MARIE (DAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:PRIESTMAN
Suffix:
Gender:F
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 N HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02163-1010
Mailing Address - Country:US
Mailing Address - Phone:617-495-2200
Mailing Address - Fax:
Practice Address - Street 1:65 N HARVARD ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02163-1010
Practice Address - Country:US
Practice Address - Phone:617-495-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAT16072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty