Provider Demographics
NPI:1063706323
Name:BRUMFIELD, DIANA SUE (CMT, CAEH)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:SUE
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:CMT, CAEH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32401 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1301
Mailing Address - Country:US
Mailing Address - Phone:248-987-2558
Mailing Address - Fax:
Practice Address - Street 1:32401 8 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1301
Practice Address - Country:US
Practice Address - Phone:248-987-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19970011225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist