Provider Demographics
NPI:1679983506
Name:STANLEY, DIANNA MARIE
Entity Type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:MARIE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DIANNA
Other - Middle Name:MARIE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 SHAWNEE ROAD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805
Mailing Address - Country:US
Mailing Address - Phone:419-999-2030
Mailing Address - Fax:419-991-0909
Practice Address - Street 1:682 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-3468
Practice Address - Country:US
Practice Address - Phone:814-723-7060
Practice Address - Fax:814-723-4544
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000449225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant