Provider Demographics
NPI:1619211166
Name:MUNAFO, DIANE MICHELLE (LPT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MICHELLE
Last Name:MUNAFO
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 S STIVERS RD
Mailing Address - Street 2:P.O. BOX 95
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-8560
Mailing Address - Country:US
Mailing Address - Phone:513-646-4073
Mailing Address - Fax:
Practice Address - Street 1:101 MILLS PL
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-1430
Practice Address - Country:US
Practice Address - Phone:937-687-1311
Practice Address - Fax:937-687-3991
Is Sole Proprietor?:No
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-005042251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics