Provider Demographics
NPI:1134289333
Name:SIWEK, DIANE M (PT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:SIWEK
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 1:5299 PARK PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1462
Mailing Address - Country:US
Mailing Address - Phone:561-573-5955
Mailing Address - Fax:
Practice Address - Street 1:5299 PARK PLACE CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1462
Practice Address - Country:US
Practice Address - Phone:561-573-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT1921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist