Provider Demographics
NPI:1902362197
Name:DIRAIMO, ANGELA M (LMT)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:M
Last Name:DIRAIMO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:DIRAIMO
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:15965 NE 85TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3593
Mailing Address - Country:US
Mailing Address - Phone:425-882-9065
Mailing Address - Fax:425-558-1900
Practice Address - Street 1:15965 NE 85TH ST STE 102
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3593
Practice Address - Country:US
Practice Address - Phone:425-882-9065
Practice Address - Fax:425-558-1900
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60726763225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist