Provider Demographics
NPI:1245766948
Name:BRIONES, DIAMOND (PTA)
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:
Last Name:BRIONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-0713
Mailing Address - Country:US
Mailing Address - Phone:903-270-2524
Mailing Address - Fax:
Practice Address - Street 1:107 EAST DALLAS STREET
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457
Practice Address - Country:US
Practice Address - Phone:903-270-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2079298225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant