Provider Demographics
NPI:1063884310
Name:TOSCA-REYNOSO, DIANA (PT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:TOSCA-REYNOSO
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 1:572 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6235
Mailing Address - Country:US
Mailing Address - Phone:508-584-0800
Mailing Address - Fax:
Practice Address - Street 1:650 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-2054
Practice Address - Country:US
Practice Address - Phone:508-378-4035
Practice Address - Fax:508-378-0542
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist