Provider Demographics
NPI:1306289038
Name:NAVARRE, DIANE (LMT, NCBTMB)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:NAVARRE
Suffix:
Gender:F
Credentials:LMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 CHURCH POINT HWY
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-7664
Mailing Address - Country:US
Mailing Address - Phone:337-298-3251
Mailing Address - Fax:
Practice Address - Street 1:3114 CHURCH POINT HWY
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-7664
Practice Address - Country:US
Practice Address - Phone:337-298-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA1978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist