Provider Demographics
NPI:1780725200
Name:LOBAUGH, DIANE MARIE (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:LOBAUGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20227 DENSMORE AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3316
Mailing Address - Country:US
Mailing Address - Phone:206-533-2337
Mailing Address - Fax:360-386-8369
Practice Address - Street 1:20227 DENSMORE AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3316
Practice Address - Country:US
Practice Address - Phone:360-658-0207
Practice Address - Fax:360-658-0507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7032857Medicaid