Provider Demographics
NPI:1235299363
Name:WASHART, DIANA (BSPT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:WASHART
Suffix:
Gender:M
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2708
Mailing Address - Country:US
Mailing Address - Phone:856-686-1580
Mailing Address - Fax:
Practice Address - Street 1:151 FRIES MILL RD
Practice Address - Street 2:BLDG. 600 STE. 1
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-374-3707
Practice Address - Fax:856-374-3709
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00518300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00228820OtherRAILROAD MCR
NJAMERIHEALTHOther0533312000
NJ083402R5AMedicare ID - Type Unspecified