Individual provider · NPI-1

Diana Denise Ellering, CMT

Massage Therapist · Roseville, CA

NPI number1306185673
StatusActive
Last updated in NPPESFeb 7, 2013

Details

NPI
1306185673
Entity type
Individual (NPI-1)
Name
Diana Denise Ellering
Credential
CMT
Sex
Female
Sole proprietor
Yes
Enumeration date
Feb 6, 2013
Last updated
Feb 7, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225700000X Massage Therapist36842CAYes

Practice location

9010 Fairway Dr
Studio 123
Roseville, CA 95678-1988

Phone 916-532-3392

Mailing address

9010 Fairway Dr
Studio 123
Roseville, CA 95678-1988

Phone 916-532-3392

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