Provider Demographics
NPI:1588070114
Name:KROFT, DIANNA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:KROFT
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N HIAWASSEE RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-2608
Mailing Address - Country:US
Mailing Address - Phone:407-297-4900
Mailing Address - Fax:
Practice Address - Street 1:2501 N HIAWASSEE RD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-2608
Practice Address - Country:US
Practice Address - Phone:407-297-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL35022255A2300X
PART0054672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer