Provider Demographics
NPI:1134479058
Name:DIANI, DENISE L (PT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:L
Last Name:DIANI
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 1:2505 CABRILLO COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3166
Mailing Address - Country:US
Mailing Address - Phone:831-464-3901
Mailing Address - Fax:831-464-3010
Practice Address - Street 1:2505 CABRILLO COLLEGE DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3166
Practice Address - Country:US
Practice Address - Phone:831-464-3901
Practice Address - Fax:831-464-3010
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist