Provider Demographics
NPI:1962634600
Name:ATTERBURY, DIANNA LYNN (LMP)
Entity type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:LYNN
Last Name:ATTERBURY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15083 179TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272
Mailing Address - Country:US
Mailing Address - Phone:425-220-7717
Mailing Address - Fax:
Practice Address - Street 1:1129 W MAIN ST
Practice Address - Street 2:STE 172
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2034
Practice Address - Country:US
Practice Address - Phone:425-220-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60103851225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist