Provider Demographics
NPI:1598786626
Name:ROTHAUSER, DIANA ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:ELIZABETH
Last Name:ROTHAUSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13819 WOOD DUCK CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-8298
Mailing Address - Country:US
Mailing Address - Phone:941-758-2328
Mailing Address - Fax:941-758-9967
Practice Address - Street 1:13819 WOOD DUCK CIR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-8298
Practice Address - Country:US
Practice Address - Phone:941-758-2328
Practice Address - Fax:941-758-9967
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist