Provider Demographics
NPI:1467784405
Name:ATSATT, DIANE KENNEDY (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KENNEDY
Last Name:ATSATT
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 1:8050 SOQUEL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3981
Mailing Address - Country:US
Mailing Address - Phone:831-684-1804
Mailing Address - Fax:
Practice Address - Street 1:8050 SOQUEL DR
Practice Address - Street 2:SUITE A
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3981
Practice Address - Country:US
Practice Address - Phone:831-684-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA158082251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics