Provider Demographics
NPI:1568538767
Name:CORDEIRO, DIANE JOAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:JOAN
Last Name:CORDEIRO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 BAY MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-2329
Mailing Address - Country:US
Mailing Address - Phone:508-880-7085
Mailing Address - Fax:508-675-0132
Practice Address - Street 1:500 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02725-2051
Practice Address - Country:US
Practice Address - Phone:508-675-7589
Practice Address - Fax:508-675-0132
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58162251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0705900Medicaid
MA0705900Medicaid