Provider Demographics
NPI:1154601185
Name:DIPERNA, MARIAN (LMT)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:DIPERNA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 53RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3623
Mailing Address - Country:US
Mailing Address - Phone:206-605-5115
Mailing Address - Fax:
Practice Address - Street 1:3727 CALIFORNIA AVE SW STE 2A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4303
Practice Address - Country:US
Practice Address - Phone:206-605-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60235348225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist