Gabriela Diaz

Individual provider Active NPI Massage Therapist · Versailles, KY

NPI 1356738652 · NPPES record last updated Apr 24, 2015

Key facts

NPI
1356738652
Entity type
Individual (NPI type 1)
Primary specialty
Massage Therapist 225700000X
License
BMTMTH00216686 (KY)
Practice address
260 Crossfield Dr
Unit 2
Versailles, KY 40383-1596
Phone
(859) 879-0024
Fax
(859) 879-1102
NPI assigned
Apr 24, 2015
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
BMTMTH00216686KYMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Versailles Chiropractic PSC Past
since Jul 5, 2007
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X BMTMTH00216686 KY Yes

Addresses

Primary practice location

260 Crossfield Dr
Unit 2
Versailles, KY 40383-1596

Mailing address

260 Crossfield Dr
Unit 2
Versailles, KY 40383-1596
Phone (859) 879-0024

Other providers in Versailles, KY

All providers in Versailles, KY · Massage Therapist in Kentucky

Sources for this page

Verify at the official NPI Registry.