Provider Demographics
NPI:1588966824
Name:MILHAN, DIANE JANE (PHD, DPT, DAOM)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:JANE
Last Name:MILHAN
Suffix:
Gender:F
Credentials:PHD, DPT, DAOM
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:J
Other - Last Name:MILHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:835 MERITA ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2763
Mailing Address - Country:US
Mailing Address - Phone:336-755-2158
Mailing Address - Fax:
Practice Address - Street 1:835 MERITA ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2763
Practice Address - Country:US
Practice Address - Phone:336-755-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13423225100000X
NC641171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073925566OtherACUPUNCTURIST