Provider Demographics
NPI:1760254825
Name:DIAZ, PATRICIA F (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:F
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:F
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1915 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3216
Mailing Address - Country:US
Mailing Address - Phone:307-333-1340
Mailing Address - Fax:
Practice Address - Street 1:1915 OXFORD LN
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3216
Practice Address - Country:US
Practice Address - Phone:307-333-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYHLTH-000604-2023225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist