Provider Demographics
NPI:1760564603
Name:DIAZ, IRIS MARGARITA (PT)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:MARGARITA
Last Name:DIAZ
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 1:2129 RIVER REACH DR
Mailing Address - Street 2:APT. 537
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6965
Mailing Address - Country:US
Mailing Address - Phone:239-643-7950
Mailing Address - Fax:239-643-7950
Practice Address - Street 1:2129 RIVER REACH DR
Practice Address - Street 2:APT. 537
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-7926
Practice Address - Country:US
Practice Address - Phone:239-643-7950
Practice Address - Fax:239-643-7950
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2913225100000X
PR322225100000X
GA006153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7234OtherBLUE CROSS/BLUE SHIELD