Provider Demographics
NPI:1073987251
Name:DIEBOLD, EMILY (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DIEBOLD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16430 VENTURA BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2115
Mailing Address - Country:US
Mailing Address - Phone:818-788-2544
Mailing Address - Fax:818-788-2610
Practice Address - Street 1:16430 VENTURA BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2115
Practice Address - Country:US
Practice Address - Phone:818-788-2544
Practice Address - Fax:818-788-2610
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist