Provider Demographics
NPI:1699743559
Name:DRYSDALE, DIANNE CAROL (PT)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:CAROL
Last Name:DRYSDALE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-5919
Mailing Address - Country:US
Mailing Address - Phone:904-241-9200
Mailing Address - Fax:
Practice Address - Street 1:2051 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-5919
Practice Address - Country:US
Practice Address - Phone:904-651-7459
Practice Address - Fax:904-241-9200
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist