Provider Demographics
NPI:1992822530
Name:DANIEL, DIANA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:68 SPRING TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6488
Mailing Address - Country:US
Mailing Address - Phone:636-669-2345
Mailing Address - Fax:636-669-2344
Practice Address - Street 1:1551 WALL ST
Practice Address - Street 2:SUITE110
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3539
Practice Address - Country:US
Practice Address - Phone:636-669-2345
Practice Address - Fax:636-669-2344
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004000454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist