Provider Demographics
NPI:1275887077
Name:DIEHL, WHITNEY (PTA)
Entity Type:Individual
Prefix:MISS
First Name:WHITNEY
Middle Name:
Last Name:DIEHL
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 1:1335 NORTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440-9407
Mailing Address - Country:US
Mailing Address - Phone:330-565-1335
Mailing Address - Fax:
Practice Address - Street 1:1335 NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440-9407
Practice Address - Country:US
Practice Address - Phone:330-565-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.08431225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant