Healthcare Provider Details

I. General information

NPI: 1679920102
Provider Name (Legal Business Name): DIANE ELAINE EPPERSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 NE 8TH WAY
VANCOUVER WA
98664-1980
US

IV. Provider business mailing address

8507 NE 8TH WAY
VANCOUVER WA
98664-1980
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-5335
  • Fax:
Mailing address:
  • Phone: 360-254-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00009169
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: