Provider Demographics
NPI:1467184358
Name:BUNDSCHU, DIANE RENEE (PTA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:RENEE
Last Name:BUNDSCHU
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 1:2656 SLAGROVE CT
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4666
Mailing Address - Country:US
Mailing Address - Phone:407-340-6887
Mailing Address - Fax:
Practice Address - Street 1:8917 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6955
Practice Address - Country:US
Practice Address - Phone:407-822-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant