Provider Demographics
NPI:1194882837
Name:HADSELL, DIANE L (PT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:L
Last Name:HADSELL
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 1:322 MINE RD
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9185
Mailing Address - Country:US
Mailing Address - Phone:608-792-6161
Mailing Address - Fax:
Practice Address - Street 1:707 14TH ST
Practice Address - Street 2:ST. CLARE HOSPITAL AND HEALTH SERVICES
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1539
Practice Address - Country:US
Practice Address - Phone:608-356-1480
Practice Address - Fax:608-356-1448
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2830-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist