Provider Demographics
NPI:1104090729
Name:FLETCHER, DIANA H (PT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:H
Last Name:FLETCHER
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 1:1626 N LITCHFIELD RD STE 310
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1397
Mailing Address - Country:US
Mailing Address - Phone:623-935-0734
Mailing Address - Fax:
Practice Address - Street 1:1626 N LITCHFIELD RD STE 310
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1397
Practice Address - Country:US
Practice Address - Phone:623-935-0734
Practice Address - Fax:623-935-0934
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1104090729OtherNPI
AZ1104090729OtherNPI