Provider Demographics
NPI:1134321821
Name:FROEHLICH, DIANE LYNNE (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LYNNE
Last Name:FROEHLICH
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2803
Mailing Address - Country:US
Mailing Address - Phone:458-522-4300
Mailing Address - Fax:
Practice Address - Street 1:155 DUNDERBERG RD
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3507
Practice Address - Country:US
Practice Address - Phone:845-460-7647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001265002255A2300X
NY001203-012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer