Provider Demographics
NPI:1225150402
Name:SWENSON, DIANE E (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:E
Last Name:SWENSON
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 1:4721 NE 25 AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6435
Mailing Address - Country:US
Mailing Address - Phone:503-281-3406
Mailing Address - Fax:
Practice Address - Street 1:4721 NE 25 AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6435
Practice Address - Country:US
Practice Address - Phone:503-281-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist