Provider Demographics
NPI:1366672263
Name:WILLISTON, DIANE CHERYL (DPT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CHERYL
Last Name:WILLISTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:CHERYL
Other - Last Name:GREENING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2237 US HIGHWAY 2 E
Mailing Address - Street 2:SUITE B
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2812
Mailing Address - Country:US
Mailing Address - Phone:406-756-7878
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:5988 STETSON HILLS BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3567
Practice Address - Country:US
Practice Address - Phone:719-574-3111
Practice Address - Fax:719-574-2912
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist