Provider Demographics
NPI:1679134530
Name:KRANE, DIANE THERESA (LMT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:THERESA
Last Name:KRANE
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 1:241 N 4TH ST # 2384
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-9998
Mailing Address - Country:US
Mailing Address - Phone:970-201-4833
Mailing Address - Fax:
Practice Address - Street 1:1521 PINYON AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8529
Practice Address - Country:US
Practice Address - Phone:970-201-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022736225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1309817OtherASSOCIATED BODYWORK AND MASSAGE PROFESSIONALS