Provider Demographics
NPI:1083182752
Name:DIEP, DIANA (DPT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DIEP
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 1:12825 MINNIEVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3602
Mailing Address - Country:US
Mailing Address - Phone:703-647-3130
Mailing Address - Fax:
Practice Address - Street 1:201 NATIONAL HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1052
Practice Address - Country:US
Practice Address - Phone:301-364-9292
Practice Address - Fax:301-552-9743
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-11
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212482225100000X
MD27719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist