Provider Demographics
NPI:1346281102
Name:PERCY, DIANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:PERCY
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 1:7606 N UNION BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3873
Mailing Address - Country:US
Mailing Address - Phone:719-667-0666
Mailing Address - Fax:719-594-5658
Practice Address - Street 1:7606 N UNION BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3850
Practice Address - Country:US
Practice Address - Phone:719-667-0666
Practice Address - Fax:719-594-5658
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO546658Medicare ID - Type Unspecified