Provider Demographics
NPI:1083035323
Name:STICH, DIANA (PT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:STICH
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 1:3838 MASSILLON RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7965
Mailing Address - Country:US
Mailing Address - Phone:330-899-5599
Mailing Address - Fax:330-899-5511
Practice Address - Street 1:3838 MASSILLON RD
Practice Address - Street 2:SUITE 320
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7965
Practice Address - Country:US
Practice Address - Phone:330-899-5599
Practice Address - Fax:330-899-5511
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-011064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist