Provider Demographics
NPI:1851524417
Name:ZIEGENHORN, DIANE (DPT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ZIEGENHORN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27401 W IL ROUTE 22
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5999
Mailing Address - Country:US
Mailing Address - Phone:847-381-8812
Mailing Address - Fax:847-381-6311
Practice Address - Street 1:27401 W IL ROUTE 22
Practice Address - Street 2:SUITE 107
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5999
Practice Address - Country:US
Practice Address - Phone:847-381-8812
Practice Address - Fax:847-381-6311
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-017384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202845178Medicare PIN
IL216859210Medicare PIN
ILIL2993018Medicare PIN