Provider Demographics
NPI:1710482914
Name:DIAZ, MEGAN RENEE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:DIAZ
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 1:3002 N WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4357
Mailing Address - Country:US
Mailing Address - Phone:509-828-3375
Mailing Address - Fax:
Practice Address - Street 1:3002 N WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4357
Practice Address - Country:US
Practice Address - Phone:509-828-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist