Provider Demographics
NPI:1154447548
Name:STROUD, DIANE T (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:T
Last Name:STROUD
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 1:4141 N HENDERSON RD
Mailing Address - Street 2:PLAZA 8
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2486
Mailing Address - Country:US
Mailing Address - Phone:703-527-8446
Mailing Address - Fax:703-527-1752
Practice Address - Street 1:4141 N HENDERSON RD
Practice Address - Street 2:PLAZA 8
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2486
Practice Address - Country:US
Practice Address - Phone:703-527-8446
Practice Address - Fax:703-527-1752
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist