Provider Demographics
NPI:1316246861
Name:DIEHM, RODNEY L (LMT)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:L
Last Name:DIEHM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 NE ELAM YOUNG PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6425
Mailing Address - Country:US
Mailing Address - Phone:503-693-1151
Mailing Address - Fax:
Practice Address - Street 1:5035 NE ELAM YOUNG PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6425
Practice Address - Country:US
Practice Address - Phone:503-693-1151
Practice Address - Fax:503-445-4464
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11410225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist