Provider Demographics
NPI:1316562010
Name:YOUNG, DIANE MARIE (MAOM, BA, LMT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MAOM, BA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 SW ARCHER RD LOT 2714
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4664
Mailing Address - Country:US
Mailing Address - Phone:706-251-2244
Mailing Address - Fax:
Practice Address - Street 1:7117 SW ARCHER RD LOT 2714
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4664
Practice Address - Country:US
Practice Address - Phone:706-251-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist