Provider Demographics
NPI:1407639800
Name:CHURCH, DIANNA (DPT)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:CHURCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 KIRKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6503
Mailing Address - Country:US
Mailing Address - Phone:425-629-3502
Mailing Address - Fax:425-629-3517
Practice Address - Street 1:1309 HARBOR AVE SW STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-1784
Practice Address - Country:US
Practice Address - Phone:206-906-9207
Practice Address - Fax:206-906-9369
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61399840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist