Provider Demographics
NPI:1477074961
Name:ARRAMBIDEZ, DIANISHA SHEREE (PTA)
Entity Type:Individual
Prefix:
First Name:DIANISHA
Middle Name:SHEREE
Last Name:ARRAMBIDEZ
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 1:3297 MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:KY
Mailing Address - Zip Code:42716-8447
Mailing Address - Country:US
Mailing Address - Phone:910-728-7637
Mailing Address - Fax:
Practice Address - Street 1:3297 MOUNT TABOR RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:KY
Practice Address - Zip Code:42716-8447
Practice Address - Country:US
Practice Address - Phone:910-728-7637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA5968225200000X
KYA03606225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant