Provider Demographics
NPI:1225340664
Name:DIAKITE, DONNA D (PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:D
Last Name:DIAKITE
Suffix:
Gender:F
Credentials:PRACTITIONER
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:D
Other - Last Name:DIAKITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DONNA D DIAKITE
Mailing Address - Street 1:345 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-2036
Mailing Address - Country:US
Mailing Address - Phone:267-257-0017
Mailing Address - Fax:
Practice Address - Street 1:110 PARK AVE STE 2
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081
Practice Address - Country:US
Practice Address - Phone:267-257-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
PA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA890752OtherMASSAGE PRACTITIONER