Provider Demographics
NPI:1215970983
Name:DININO, DIANE (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DININO
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 1:9358 94TH PLACE
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373
Mailing Address - Country:US
Mailing Address - Phone:219-365-7093
Mailing Address - Fax:
Practice Address - Street 1:9711 VALPARAISO DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2866
Practice Address - Country:US
Practice Address - Phone:219-924-3512
Practice Address - Fax:219-924-3524
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002237A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN165880Medicare PIN
IN650021302Medicare PIN