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NPI Code Detail

MEDICARE: MS. WAHNETA TONN DIMMER LMT

MEDICARE: MS. WAHNETA TONN DIMMER LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist2542IA

General Provider Information

NPI Number : 1023527579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. WAHNETA TONN DIMMER LMT
Provider Business Mailing Address
First Line : 1615 32ND ST NE STE 3
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-4072
Country : US
Telephone Number : 319-366-5454
Fax Number :
Provider Business Practice Location Address
First Line : 1615 32ND ST NE STE 3
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-4072
Country : US
Telephone Number : 319-366-5454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2017
Last Update Date : 07/21/2022

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