Provider Demographics
NPI:1659463693
Name:SCHWAB, DIANE RADOVICH (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:RADOVICH
Last Name:SCHWAB
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:RADOVICH
Other - Last Name:MOYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:2918 5TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5910
Mailing Address - Country:US
Mailing Address - Phone:619-497-1890
Mailing Address - Fax:619-497-1857
Practice Address - Street 1:2918 5TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5910
Practice Address - Country:US
Practice Address - Phone:619-497-1890
Practice Address - Fax:619-497-1857
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist