Provider Demographics
NPI:1689291544
Name:MATTHEWS, DIANA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:FILIPA
Other - Last Name:DA COSTA FELIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6016 JERRYS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3823
Mailing Address - Country:US
Mailing Address - Phone:301-788-6770
Mailing Address - Fax:
Practice Address - Street 1:6016 JERRYS DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:301-788-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist