Provider Demographics
NPI:1043273725
Name:BONESTEEL, DIANE E (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:E
Last Name:BONESTEEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:E
Other - Last Name:POETTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:42 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3412
Mailing Address - Country:US
Mailing Address - Phone:518-399-0062
Mailing Address - Fax:518-399-4513
Practice Address - Street 1:42 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-3412
Practice Address - Country:US
Practice Address - Phone:518-399-0062
Practice Address - Fax:518-399-4513
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0170121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02626488Medicaid
NYRA5093Medicare ID - Type Unspecified
NY02626488Medicaid