Provider Demographics
NPI:1679370803
Name:PRINCE, DIANNA
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:PRINCE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 NORTHCROSS DR # 9151
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1715
Mailing Address - Country:US
Mailing Address - Phone:512-410-0276
Mailing Address - Fax:
Practice Address - Street 1:10603 METRIC BLVD STE 106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4528
Practice Address - Country:US
Practice Address - Phone:512-410-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist