Provider Demographics
NPI:1760092381
Name:DIAZ, LINO JR (DPT)
Entity Type:Individual
Prefix:DR
First Name:LINO
Middle Name:
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 EVERGREEN WOOD TRAIL
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608
Mailing Address - Country:US
Mailing Address - Phone:352-596-8371
Mailing Address - Fax:
Practice Address - Street 1:4109 N ARMENIA AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6411
Practice Address - Country:US
Practice Address - Phone:813-588-3342
Practice Address - Fax:813-588-3602
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist