Provider Demographics
NPI:1285942821
Name:WATSON, DIANE SOELLNER (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:SOELLNER
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:ROBIN
Other - Last Name:SOELLNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:601 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1325
Mailing Address - Country:US
Mailing Address - Phone:860-298-9079
Mailing Address - Fax:860-683-2398
Practice Address - Street 1:601 RIVER ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1325
Practice Address - Country:US
Practice Address - Phone:860-298-9079
Practice Address - Fax:860-683-2398
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist