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General NPI Number Information
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NPI Number | 1679370803
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Entity Type | Individual
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Provider Name | DIANNA PRINCE
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Gender |
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 10603 METRIC BLVD STE 106
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City | AUSTIN
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State | TX
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Zip | 78758-4528
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Country | US
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Telephone | 512-410-0276
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 NORTHCROSS DR # 9151
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City | AUSTIN
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State | TX
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Zip | 78757-1715
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Country | US
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Telephone | 512-410-0276
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Fax |
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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 |
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License Number State |
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