Provider Demographics
NPI:1740752724
Name:STUBEDA-KINGMAN, DIANE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:STUBEDA-KINGMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 CAMBRIDGE ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3735
Mailing Address - Country:US
Mailing Address - Phone:781-272-2536
Mailing Address - Fax:
Practice Address - Street 1:31 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6126
Practice Address - Country:US
Practice Address - Phone:339-368-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist