Provider Demographics
NPI:1639485774
Name:SANGREE, DIANE KAREN (PTA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KAREN
Last Name:SANGREE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 WELLS MILL RD
Mailing Address - Street 2:
Mailing Address - City:WARETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08758-2607
Mailing Address - Country:US
Mailing Address - Phone:609-971-3187
Mailing Address - Fax:
Practice Address - Street 1:174 WELLS MILL RD
Practice Address - Street 2:
Practice Address - City:WARETOWN
Practice Address - State:NJ
Practice Address - Zip Code:08758-2607
Practice Address - Country:US
Practice Address - Phone:609-971-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00141100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant