Provider Demographics
NPI:1376955203
Name:HEALEYDALE, DIANE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:HEALEYDALE
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 1:116 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19362
Mailing Address - Country:US
Mailing Address - Phone:610-217-5311
Mailing Address - Fax:
Practice Address - Street 1:116 SUNSET DR
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:PA
Practice Address - Zip Code:19362-9018
Practice Address - Country:US
Practice Address - Phone:610-217-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1003186225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant