Provider Demographics
NPI:1083982532
Name:ANTLEY, DIANE LEE (MS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LEE
Last Name:ANTLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 WATTERS RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5701
Mailing Address - Country:US
Mailing Address - Phone:908-887-1754
Mailing Address - Fax:908-333-6262
Practice Address - Street 1:145 STATE PARK ROAD
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:NJ
Practice Address - Zip Code:07844
Practice Address - Country:US
Practice Address - Phone:908-459-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA007269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist