Provider Demographics
NPI:1477759082
Name:HARRISON, DIANA ARLENE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ARLENE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-1761
Mailing Address - Country:US
Mailing Address - Phone:573-392-8248
Mailing Address - Fax:
Practice Address - Street 1:116 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1761
Practice Address - Country:US
Practice Address - Phone:573-392-8248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002026960225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist