Provider Demographics
NPI:1073098281
Name:HEATH, DIANA GUADALUPE (PT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:GUADALUPE
Last Name:HEATH
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 1:13808 N LAKE BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-1495
Mailing Address - Country:US
Mailing Address - Phone:512-517-0320
Mailing Address - Fax:832-375-6540
Practice Address - Street 1:17600 CALI DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2703
Practice Address - Country:US
Practice Address - Phone:832-375-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist