Provider Demographics
NPI:1659610301
Name:CALVOPINA, DIANNE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:MARIE
Last Name:CALVOPINA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 E LAKE LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-4183
Mailing Address - Country:US
Mailing Address - Phone:847-670-8377
Mailing Address - Fax:
Practice Address - Street 1:1454 E LAKE LOUISE DR
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-4183
Practice Address - Country:US
Practice Address - Phone:847-670-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist