Provider Demographics
NPI:1275296592
Name:DOUGLASS, DIANA (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352800
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-2800
Mailing Address - Country:US
Mailing Address - Phone:206-543-7442
Mailing Address - Fax:
Practice Address - Street 1:1660 S COLUMBIAN WAY # 117-RCS
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-543-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist