Provider Demographics
NPI:1770943300
Name:PITTMAN, DIANDRA MARIE (LMT)
Entity type:Individual
Prefix:
First Name:DIANDRA
Middle Name:MARIE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3361 GENERAL DE GAULLE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6701
Mailing Address - Country:US
Mailing Address - Phone:504-331-5289
Mailing Address - Fax:504-323-3494
Practice Address - Street 1:3361 GENERAL DE GAULLE DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6701
Practice Address - Country:US
Practice Address - Phone:504-331-5289
Practice Address - Fax:504-323-3494
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA3308225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist