Provider Demographics
NPI:1063236511
Name:DIAZ, ADRIAUNA (LMT, CMLDT)
Entity type:Individual
Prefix:
First Name:ADRIAUNA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 CARDING MACHINE RD
Mailing Address - Street 2:
Mailing Address - City:BOWDOINHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04008-5405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:458 CARDING MACHINE RD
Practice Address - Street 2:
Practice Address - City:BOWDOINHAM
Practice Address - State:ME
Practice Address - Zip Code:04008-5405
Practice Address - Country:US
Practice Address - Phone:207-797-5868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT7745225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist