Provider Demographics
NPI:1891828430
Name:SMITH, DIANNE E (MPT)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:E
Other - Last Name:MCDOWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1545 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3814
Mailing Address - Country:US
Mailing Address - Phone:951-791-1111
Mailing Address - Fax:951-925-3606
Practice Address - Street 1:1515 W FLORIDA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3817
Practice Address - Country:US
Practice Address - Phone:951-658-3121
Practice Address - Fax:951-652-6994
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0PT185890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT185890Medicare ID - Type Unspecified