Individual
DIANA LEE BLACKLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
2426 20TH ST SE, PUYALLUP, WA 98374-1475
(253) 229-4272
Mailing address
2426 20TH ST SE, PUYALLUP, WA 98374-1475
(253) 229-4272
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60141204
LICENSED MASSAGE THERAPISTS
WA
Enumeration date
05/17/2010
Last updated
05/17/2010
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