Provider Demographics
NPI:1003117748
Name:OSMAN, DIANA KAMAL (PTA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:KAMAL
Last Name:OSMAN
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 1:11119 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9717
Mailing Address - Country:US
Mailing Address - Phone:810-937-9150
Mailing Address - Fax:
Practice Address - Street 1:5601 HATCHERY RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3451
Practice Address - Country:US
Practice Address - Phone:248-674-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001711225200000X
TX22077702225200000X
TX1323107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant