Provider Demographics
NPI:1386799732
Name:DIEHL, JANE ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANN
Last Name:DIEHL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JANE
Other - Middle Name:ANN
Other - Last Name:CRESSOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2600 ARMOUR LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-5327
Mailing Address - Country:US
Mailing Address - Phone:310-379-4628
Mailing Address - Fax:
Practice Address - Street 1:2600 ARMOUR LN
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-5327
Practice Address - Country:US
Practice Address - Phone:310-379-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0089820Medicare ID - Type Unspecified