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NPI Code Detail

MEDICARE: DIANA MAINS LMT

MEDICARE: DIANA MAINS LMT
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 TherapistMT5477ME

General Provider Information

NPI Number : 1396214300
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA MAINS LMT
Provider Business Mailing Address
First Line : 72 JOE BERRY RD
Second Line :
City : CORNISH
State : ME
Zip : 04020-3720
Country : US
Telephone Number : 207-310-3897
Fax Number :
Provider Business Practice Location Address
First Line : 31 MAPLE ST
Second Line :
City : CORNISH
State : ME
Zip : 04020-3101
Country : US
Telephone Number : 207-619-0994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2018
Last Update Date : 11/19/2018

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Directions to “ DIANA MAINS LMT” Practice Location

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