Provider Demographics
NPI:1548606825
Name:DIAZ, XIOMARA I (BSCPT)
Entity Type:Individual
Prefix:
First Name:XIOMARA
Middle Name:I
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 KEENESBURG CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-8270
Mailing Address - Country:US
Mailing Address - Phone:970-412-9314
Mailing Address - Fax:
Practice Address - Street 1:709 KEENESBURG CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-8270
Practice Address - Country:US
Practice Address - Phone:970-412-9314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47472251X0800X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic