Provider Demographics
NPI:1417163841
Name:SENIOR, DIANE CHRISTINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CHRISTINE
Last Name:SENIOR
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 1:29830 CORTE CRUZADA
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584
Mailing Address - Country:US
Mailing Address - Phone:951-672-0649
Mailing Address - Fax:
Practice Address - Street 1:36485 INLAND VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595
Practice Address - Country:US
Practice Address - Phone:951-696-2604
Practice Address - Fax:951-677-9788
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist