Provider Demographics
NPI:1215083787
Name:BILLICK, DIANA L (MPT)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:L
Last Name:BILLICK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3784
Mailing Address - Country:US
Mailing Address - Phone:701-663-0480
Mailing Address - Fax:701-663-9046
Practice Address - Street 1:1302 1ST ST NE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3784
Practice Address - Country:US
Practice Address - Phone:701-663-0480
Practice Address - Fax:701-663-9046
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN70790Medicare UPIN