Provider Demographics
NPI:1649582545
Name:MILLSPAUGH, DIANA F (DPT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:F
Last Name:MILLSPAUGH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:F
Other - Last Name:MITSCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:
Practice Address - Street 1:15312 W BELOIT RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7447
Practice Address - Country:US
Practice Address - Phone:262-641-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
NY042668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1649582545Medicaid
WI832070033Medicare PIN
WI830420050Medicare PIN