Provider Demographics
NPI:1659865038
Name:PROIMOS, DIAMANDO K (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DIAMANDO
Middle Name:K
Last Name:PROIMOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 E THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6682
Mailing Address - Country:US
Mailing Address - Phone:317-782-8888
Mailing Address - Fax:317-788-4640
Practice Address - Street 1:3215 E THOMPSON RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:317-782-8888
Practice Address - Fax:317-788-4640
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99086817A2251P0200X
IN05013028A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics