Provider Demographics
NPI:1326372996
Name:TAYLOR, DIANA (PT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:TAYLOR
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 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:1331 E WYOMING AVE
Practice Address - Street 2:SUITE 4120
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3808
Practice Address - Country:US
Practice Address - Phone:215-831-1170
Practice Address - Fax:215-744-7394
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10002489225100000X
PAPT-20449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30080473OtherKEYSTONE MERCY
PA102466580-0001Medicaid
299173OtherUNISON
DE3746089000OtherIBC
DE1326372996OtherDPCI
PA2140245OtherPA BLUE SHIELD
PA182859VLZMedicare PIN
DE177325ZB82Medicare PIN