Provider Demographics
NPI:1730979279
Name:DIMAGGIO, DEANA (MA 61637963)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:DIMAGGIO
Suffix:
Gender:
Credentials:MA 61637963
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16323 29TH PL NE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-4585
Mailing Address - Country:US
Mailing Address - Phone:425-293-4700
Mailing Address - Fax:
Practice Address - Street 1:16323 29TH PL NE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-4585
Practice Address - Country:US
Practice Address - Phone:425-293-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61637963225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist