Individual
DIANA WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2159 JOEY CANYON DR, NEWPORT, MI 48166-9569
(586) 745-1160
Mailing address
2159 JOEY CANYON DR, NEWPORT, MI 48166-9569
(586) 745-1160
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501005910
MI
Other
Enumeration date
11/15/2019
Last updated
11/15/2019
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