Provider Demographics
NPI:1609306257
Name:ROAR, DIANA (MA 60758945)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ROAR
Suffix:
Gender:F
Credentials:MA 60758945
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:SCHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA 60758945
Mailing Address - Street 1:4461 LINDEN AVE N APT 301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:916 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5542
Practice Address - Country:US
Practice Address - Phone:206-267-0863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60758945225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist