Provider Demographics
NPI:1124314331
Name:DIGNAM, DIANA MARCINEK (PT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARCINEK
Last Name:DIGNAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:HELEN
Other - Last Name:MARCINEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:414 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5643
Mailing Address - Country:US
Mailing Address - Phone:978-681-0433
Mailing Address - Fax:
Practice Address - Street 1:360 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1740
Practice Address - Country:US
Practice Address - Phone:978-552-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist