Provider Demographics
NPI:1568100485
Name:NACZAS, DIANE SUSAN (MSPT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:SUSAN
Last Name:NACZAS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3452
Mailing Address - Country:US
Mailing Address - Phone:351-201-9028
Mailing Address - Fax:
Practice Address - Street 1:101 ARCH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1130
Practice Address - Country:US
Practice Address - Phone:212-287-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8785261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy