Provider Demographics
NPI:1932279510
Name:HARBERS, DIANNE MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:MARIE
Last Name:HARBERS
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 1:880 BRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8703
Mailing Address - Country:US
Mailing Address - Phone:386-574-8514
Mailing Address - Fax:
Practice Address - Street 1:58 N CHARLES RICHARD BEALL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2507
Practice Address - Country:US
Practice Address - Phone:386-668-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA10126225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist