Provider Demographics
NPI:1912972233
Name:DIAZ, LINDA GAZZILLO (EDD, ATC, LMT)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:GAZZILLO
Last Name:DIAZ
Suffix:
Gender:F
Credentials:EDD, ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2410
Mailing Address - Country:US
Mailing Address - Phone:973-835-5858
Mailing Address - Fax:973-835-5858
Practice Address - Street 1:WILLIAM PATERSON UNIVERSITY OF NEW JERSEY
Practice Address - Street 2:DEPARTMENT OF EXERCISE AND MOVEMENT SCIENCES
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-720-2364
Practice Address - Fax:973-720-2034
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000648002255A2300X
FLMA14060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist