Provider Demographics
NPI:1619113289
Name:SOCHA, DIANE CAROLINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CAROLINE
Last Name:SOCHA
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 1:11785 E MARIPOSA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5661
Mailing Address - Country:US
Mailing Address - Phone:480-513-8727
Mailing Address - Fax:480-513-3359
Practice Address - Street 1:11785 E MARIPOSA GRANDE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5661
Practice Address - Country:US
Practice Address - Phone:480-513-8727
Practice Address - Fax:480-513-3359
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-01
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist