Provider Demographics
NPI:1417028580
Name:TODD, DIANE H (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:H
Last Name:TODD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8584 EDEN ISLES LN
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-6800
Mailing Address - Country:US
Mailing Address - Phone:321-795-6007
Mailing Address - Fax:321-779-1332
Practice Address - Street 1:7025 N WICKHAM RD
Practice Address - Street 2:SUITE 111
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7534
Practice Address - Country:US
Practice Address - Phone:321-752-9778
Practice Address - Fax:321-752-9178
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT21028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist