Provider Demographics
NPI:1740502640
Name:FERNANDEZ, DIANE J (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:159 W MAPLEHURST ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2716
Mailing Address - Country:US
Mailing Address - Phone:248-821-8555
Mailing Address - Fax:248-548-6657
Practice Address - Street 1:159 W MAPLEHURST ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2716
Practice Address - Country:US
Practice Address - Phone:248-821-8555
Practice Address - Fax:248-548-6657
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist