Provider Demographics
NPI:1588781264
Name:REISS, DIANA AIMEE (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:AIMEE
Last Name:REISS
Suffix:
Gender:
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 N PALM DR 207
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:432 N PALM DR
Practice Address - Street 2:207
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-3951
Practice Address - Country:US
Practice Address - Phone:323-965-7713
Practice Address - Fax:323-978-6860
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29826225100000X
NY049595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT29826BMedicare ID - Type Unspecified