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NPI Code Detail

MEDICARE: DIANA STIVERS

MEDICARE: DIANA STIVERS
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 TherapistMA60566434WA

General Provider Information

NPI Number : 1174185664
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA STIVERS
Provider Business Mailing Address
First Line : 3001 PARKINGTON PL SE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-5770
Country : US
Telephone Number : 386-288-3320
Fax Number :
Provider Business Practice Location Address
First Line : 11515 BURNHAM DR NW
Second Line :
City : GIG HARBOR
State : WA
Zip : 98332-8543
Country : US
Telephone Number : 253-858-5152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2019
Last Update Date : 07/03/2019

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Directions to “ DIANA STIVERS ” Practice Location

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