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General NPI Number Information
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NPI Number | 1609133230
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Entity Type | Individual
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Provider Name | DIANE KINGSLEY RD
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Gender | Female
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 333 17TH ST STE W
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City | VERO BEACH
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State | FL
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Zip | 32960-5687
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Country | US
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Telephone | 772-538-2960
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Fax | 772-800-1050
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Provider Business Mailing Address
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Address Line | 333 17TH ST STE W
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City | VERO BEACH
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State | FL
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Zip | 32960-5687
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Country | US
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Telephone | 772-538-2960
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Fax | 772-800-1050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 50325
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND7147
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License Number State | FL
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