Provider Demographics
NPI:1811577133
Name:SUAREZ ALDANA, DIANA CAROLINA (PTA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CAROLINA
Last Name:SUAREZ ALDANA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15210 AMBERLY DR APT 225
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2186
Mailing Address - Country:US
Mailing Address - Phone:786-609-2084
Mailing Address - Fax:
Practice Address - Street 1:701 N WILDER RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-7547
Practice Address - Country:US
Practice Address - Phone:813-752-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA30565225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant