Provider Demographics
NPI:1346866258
Name:LALA, DEANNA (LMT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:LALA
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 1:300 VIRGIL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-9569
Mailing Address - Country:US
Mailing Address - Phone:319-895-8655
Mailing Address - Fax:319-895-8651
Practice Address - Street 1:300 VIRGIL AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-9569
Practice Address - Country:US
Practice Address - Phone:319-895-8655
Practice Address - Fax:319-895-8651
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist