Provider Demographics
NPI:1619166949
Name:DIAMOND, JODI SAMARA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:SAMARA
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 VILLAGE SQUARE XING STE 118
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4540
Mailing Address - Country:US
Mailing Address - Phone:410-830-0619
Mailing Address - Fax:561-462-1761
Practice Address - Street 1:800 VILLAGE SQUARE CROSSING
Practice Address - Street 2:SUITE 118
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5483
Practice Address - Country:US
Practice Address - Phone:410-830-0619
Practice Address - Fax:561-462-1761
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37420225100000X
MD19223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist