Provider Demographics
NPI:1275101065
Name:HUYNH, DIANA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 BLACKBURN ST APT 4109
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3210
Mailing Address - Country:US
Mailing Address - Phone:817-894-2061
Mailing Address - Fax:
Practice Address - Street 1:1761 INTERNATIONAL PKWY STE 135
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1864
Practice Address - Country:US
Practice Address - Phone:972-845-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1334311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist