Provider Demographics
NPI:1396964508
Name:DIEHL, PIPER AMYRE (MASSAGE PRACTICIONER)
Entity type:Individual
Prefix:
First Name:PIPER
Middle Name:AMYRE
Last Name:DIEHL
Suffix:
Gender:F
Credentials:MASSAGE PRACTICIONER
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 65381
Mailing Address - Street 2:
Mailing Address - City:PORT LUDLOW
Mailing Address - State:WA
Mailing Address - Zip Code:98365-0381
Mailing Address - Country:US
Mailing Address - Phone:360-437-3798
Mailing Address - Fax:
Practice Address - Street 1:91 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:PORT LUDLOW
Practice Address - State:WA
Practice Address - Zip Code:98365-9762
Practice Address - Country:US
Practice Address - Phone:360-437-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA11663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist