Provider Demographics
NPI:1194873968
Name:DALLAP-PHILLIPS, DIANE LYN (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LYN
Last Name:DALLAP-PHILLIPS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:LYN
Other - Last Name:DALLAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:NRH REGIONAL REHAB - SUITE 600
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-581-8054
Mailing Address - Fax:301-564-0284
Practice Address - Street 1:1420 KEY HWY STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5550
Practice Address - Country:US
Practice Address - Phone:410-230-7830
Practice Address - Fax:410-230-7831
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD190462251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports