Provider Demographics
NPI:1467675934
Name:GIRARD-SIMONE, DIANE MICHELE (PT, M OF ED)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MICHELE
Last Name:GIRARD-SIMONE
Suffix:
Gender:F
Credentials:PT, M OF ED
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MICHELE
Other - Last Name:GIRARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-1728
Mailing Address - Country:US
Mailing Address - Phone:978-297-0609
Mailing Address - Fax:
Practice Address - Street 1:32 HOSPITAL HILL RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2302
Practice Address - Country:US
Practice Address - Phone:978-632-5477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist