Provider Demographics
NPI:1750632931
Name:DULL, DIANNA LYNN (LPTA)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:LYNN
Last Name:DULL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7722 SWEETGUM DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3462
Mailing Address - Country:US
Mailing Address - Phone:469-569-5568
Mailing Address - Fax:
Practice Address - Street 1:7722 SWEETGUM DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3462
Practice Address - Country:US
Practice Address - Phone:469-569-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2029767225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2029767OtherLICENSE NUMBER
TX2029767OtherLICENSED PHYSICAL THERAPIST ASSISTANT