Healthcare Provider Details

I. General information

NPI: 1306551205
Provider Name (Legal Business Name): DIANE WYSOCKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 HENDERSONVILLE RD STE 13
ASHEVILLE NC
28803-2192
US

IV. Provider business mailing address

1998 HENDERSONVILLE RD STE 13
ASHEVILLE NC
28803-2192
US

V. Phone/Fax

Practice location:
  • Phone: 828-277-7672
  • Fax:
Mailing address:
  • Phone: 828-277-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20805
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: