Provider Demographics
NPI:1063544344
Name:SHEEHAN, DIANE M (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:60 NORTH MAIN ST
Mailing Address - Street 2:STE 7
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760
Mailing Address - Country:US
Mailing Address - Phone:508-653-0773
Mailing Address - Fax:508-653-3879
Practice Address - Street 1:60 NORTH MAIN ST
Practice Address - Street 2:STE 7
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760
Practice Address - Country:US
Practice Address - Phone:508-653-0773
Practice Address - Fax:508-653-3879
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA614130OtherHARVARD PILGRIM
MA711923OtherTUFTS
MA0327999Medicaid
MAY65084OtherBCBS
MAY65084OtherBCBS