Provider Demographics
NPI:1427223213
Name:DIANNE PERNETTI LMT LLC
Entity Type:Organization
Organization Name:DIANNE PERNETTI LMT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:PERNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-940-5955
Mailing Address - Street 1:4426 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3310
Mailing Address - Country:US
Mailing Address - Phone:503-940-5955
Mailing Address - Fax:
Practice Address - Street 1:4426 SE 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3310
Practice Address - Country:US
Practice Address - Phone:503-940-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5464172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR113218OtherKAISER PERMENANTE