Provider Demographics
NPI:1114547106
Name:CYMERMAN, DIANE M (PTA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:CYMERMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8949 GLENSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-4417
Mailing Address - Country:US
Mailing Address - Phone:708-478-7052
Mailing Address - Fax:
Practice Address - Street 1:8949 GLENSHIRE ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-4417
Practice Address - Country:US
Practice Address - Phone:708-478-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160000516225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000516OtherPTA
IL000516OtherLISCENSE
IL000516OtherPTA LISCENSE