Provider Demographics
NPI:1376645184
Name:CALDWELL, DIANE C (PT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:C
Last Name:CALDWELL
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:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-0732
Mailing Address - Country:US
Mailing Address - Phone:603-256-2781
Mailing Address - Fax:603-526-2618
Practice Address - Street 1:75 NEWPORT RD
Practice Address - Street 2:3
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5467
Practice Address - Country:US
Practice Address - Phone:603-526-2781
Practice Address - Fax:603-526-2618
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0806506Y0NH01OtherANTHEM
NH199OtherLICENSE
NH0806506Y0NH01OtherANTHEM