Provider Demographics
NPI:1528682168
Name:DIADEM PHYSICAL THERAPY
Entity type:Organization
Organization Name:DIADEM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DRABEK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-440-8282
Mailing Address - Street 1:PO BOX 701135
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-1135
Mailing Address - Country:US
Mailing Address - Phone:210-541-2077
Mailing Address - Fax:210-437-3103
Practice Address - Street 1:403 HEIMER RD APT 514
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4891
Practice Address - Country:US
Practice Address - Phone:210-541-2077
Practice Address - Fax:210-437-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty