Provider Demographics
NPI:1063756237
Name:MAYANTS, DIANA (DPT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MAYANTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 E 68TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4915
Mailing Address - Country:US
Mailing Address - Phone:646-389-6010
Mailing Address - Fax:646-357-3577
Practice Address - Street 1:9 E 68TH ST STE B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4915
Practice Address - Country:US
Practice Address - Phone:646-389-6010
Practice Address - Fax:646-357-3577
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036359-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic