Provider Demographics
NPI:1013192665
Name:WOODMAN, DIANE (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WOODMAN
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 1:176 MAIN ST
Mailing Address - Street 2:KENNEDY DONOVAN CENTER
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-2561
Mailing Address - Country:US
Mailing Address - Phone:508-765-0292
Mailing Address - Fax:508-765-0294
Practice Address - Street 1:176 MAIN ST
Practice Address - Street 2:KENNEDY DONOVAN CENTER
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-2561
Practice Address - Country:US
Practice Address - Phone:508-765-0292
Practice Address - Fax:508-765-0294
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist