Provider Demographics
NPI:1740574359
Name:THURMAN, DIANE PEELER (MSPT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:PEELER
Last Name:THURMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:PEELER
Other - Last Name:THURMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPT
Mailing Address - Street 1:18922 HILTON DR
Mailing Address - Street 2:18922 HILTON DRIVE
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7238
Mailing Address - Country:US
Mailing Address - Phone:248-552-9745
Mailing Address - Fax:
Practice Address - Street 1:18922 HILTON DR
Practice Address - Street 2:18922 HILTON DRIVE
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7238
Practice Address - Country:US
Practice Address - Phone:248-552-9745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004949171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor