Provider Demographics
NPI:1558901454
Name:STEARNS, DIANE LYN (C,PTA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYN
Last Name:STEARNS
Suffix:
Gender:F
Credentials:C,PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SELECT REHABILITATION, LLC
Mailing Address - Street 2:2600 COMPASS ROAD
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026
Mailing Address - Country:US
Mailing Address - Phone:877-787-3430
Mailing Address - Fax:847-441-0734
Practice Address - Street 1:SAMARITAS SENIOR LIVING
Practice Address - Street 2:460 PEARL STREET
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601
Practice Address - Country:US
Practice Address - Phone:231-775-0101
Practice Address - Fax:231-775-1390
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002455225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant