Provider Demographics
NPI:1932286507
Name:PARKER, DIANNE M (LMT)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:M
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MALABAR
Other - Middle Name:M
Other - Last Name:MASSAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1573 WEIR ST
Mailing Address - Street 2:
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-3330
Mailing Address - Country:US
Mailing Address - Phone:321-768-2470
Mailing Address - Fax:
Practice Address - Street 1:1573 WEIR ST
Practice Address - Street 2:
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950-3330
Practice Address - Country:US
Practice Address - Phone:321-768-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39052225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist