Provider Demographics
NPI:1295866549
Name:HENGERER, DIANA (LMT)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:HENGERER
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 1:18119 PILKINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7045
Mailing Address - Country:US
Mailing Address - Phone:503-968-7662
Mailing Address - Fax:503-684-8220
Practice Address - Street 1:18119 PILKINGTON RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7045
Practice Address - Country:US
Practice Address - Phone:503-968-7662
Practice Address - Fax:503-684-8220
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5190225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist