Provider Demographics
NPI:1043236268
Name:DAMIANO, DIANE LOUISE (PHD PT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LOUISE
Last Name:DAMIANO
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Gender:F
Credentials:PHD PT
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Mailing Address - Street 1:7425 FORSYTH BLVD
Mailing Address - Street 2:C B 8221
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2171
Mailing Address - Country:US
Mailing Address - Phone:314-362-7327
Mailing Address - Fax:314-747-0917
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 8A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7327
Practice Address - Fax:314-747-0917
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-03-27
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Provider Licenses
StateLicense IDTaxonomies
MO2002003276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN