Provider Demographics
NPI:1457516387
Name:ADAIR, DIANA VAUN (LMT, CNMT)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:VAUN
Last Name:ADAIR
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:VAUN
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, CNMT
Mailing Address - Street 1:2020 W COLORADO AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3882
Mailing Address - Country:US
Mailing Address - Phone:719-337-9575
Mailing Address - Fax:719-634-2392
Practice Address - Street 1:2020 W COLORADO AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3882
Practice Address - Country:US
Practice Address - Phone:719-337-9575
Practice Address - Fax:719-634-2392
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO712938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist