Provider Demographics
NPI:1316691363
Name:SAILOR, DIANA (PTA)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:SAILOR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:ROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 CHAMPLAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4431
Mailing Address - Country:US
Mailing Address - Phone:631-235-0778
Mailing Address - Fax:
Practice Address - Street 1:1650 S STONEBRIDGE DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-5660
Practice Address - Country:US
Practice Address - Phone:972-529-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2179186225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant