Provider Demographics
NPI:1053448845
Name:DIAMOND, LAURA (PT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:DIAMOND
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:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-0262
Mailing Address - Country:US
Mailing Address - Phone:617-803-8730
Mailing Address - Fax:
Practice Address - Street 1:410 BOSTON POST RD STE 29
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3034
Practice Address - Country:US
Practice Address - Phone:617-803-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist