Provider Demographics
NPI:1710105804
Name:GAIDON, DIANE (PT,MS,OCS,CFMT)
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:
Last Name:GAIDON
Suffix:
Gender:F
Credentials:PT,MS,OCS,CFMT
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:WALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3324
Mailing Address - Country:US
Mailing Address - Phone:516-445-8841
Mailing Address - Fax:631-592-9894
Practice Address - Street 1:23 WHITNEY DR
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3324
Practice Address - Country:US
Practice Address - Phone:516-445-8841
Practice Address - Fax:631-592-9894
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist