Provider Demographics
NPI:1083182752
Name:DIEP, DIANA (DPT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DIEP
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 1:2800 S SHIRLINGTON RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3605
Mailing Address - Country:US
Mailing Address - Phone:703-892-6500
Mailing Address - Fax:703-521-3415
Practice Address - Street 1:3299 WOODBURN RD STE 480
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-7333
Practice Address - Country:US
Practice Address - Phone:703-892-6500
Practice Address - Fax:703-521-3415
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27719225100000X
VA2305212482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist