Individual
MRS. DIANA LYNN BLACKWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
111 S 4TH ST, CLARKSBURG, WV 26301-2801
(304) 680-1580
Mailing address
111 S 4TH ST, CLARKSBURG, WV 26301-2801
(304) 680-1580
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2009-2570
WV
Other
Enumeration date
07/14/2009
Last updated
07/14/2009
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