Provider Demographics
NPI:1710302633
Name:GROSS, DIANA ELIZABETH (DPT)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:ELIZABETH
Last Name:GROSS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 SW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3613
Mailing Address - Country:US
Mailing Address - Phone:305-725-8693
Mailing Address - Fax:
Practice Address - Street 1:4918 SW 90TH AVE
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3613
Practice Address - Country:US
Practice Address - Phone:305-725-8693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist