Provider Demographics
NPI:1275391716
Name:BINSTED, DIANA LYNN (MT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:BINSTED
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23618 YOUPON LAKE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-7683
Mailing Address - Country:US
Mailing Address - Phone:832-436-8371
Mailing Address - Fax:
Practice Address - Street 1:10857 KUYKENDAHL RD STE 160
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-2937
Practice Address - Country:US
Practice Address - Phone:832-436-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT023575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist