Provider Demographics
NPI:1912601451
Name:SMALLS, DIAMOND JHANE (PTA)
Entity type:Individual
Prefix:MS
First Name:DIAMOND
Middle Name:JHANE
Last Name:SMALLS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-2927
Mailing Address - Country:US
Mailing Address - Phone:386-337-5712
Mailing Address - Fax:
Practice Address - Street 1:1001 ALABASTER WAY FL 32725
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-4324
Practice Address - Country:US
Practice Address - Phone:386-221-2723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31612225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant