Provider Demographics
NPI:1306027222
Name:ANDERSON, DIANE LEE (RPT)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HILLCREST DR S
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1608
Mailing Address - Country:US
Mailing Address - Phone:610-730-4196
Mailing Address - Fax:
Practice Address - Street 1:305 CHERRY ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1803
Practice Address - Country:US
Practice Address - Phone:800-974-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000341E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist