Provider Demographics
NPI:1134659915
Name:AMMON, DIANNA JEAN (LMP)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:JEAN
Last Name:AMMON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13052
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:WA
Mailing Address - Zip Code:98013-0052
Mailing Address - Country:US
Mailing Address - Phone:206-271-4701
Mailing Address - Fax:
Practice Address - Street 1:17731 VASHON HIGHWAY SW
Practice Address - Street 2:VASHON INTUITIVE ARTS
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070
Practice Address - Country:US
Practice Address - Phone:206-463-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602438717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist