Provider Demographics
NPI:1508182551
Name:DIMINO, LEAH
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:DIMINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11335 SE 179TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6583
Mailing Address - Country:US
Mailing Address - Phone:206-383-7110
Mailing Address - Fax:
Practice Address - Street 1:11335 SE 179TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6583
Practice Address - Country:US
Practice Address - Phone:206-383-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist