Provider Demographics
NPI:1912045576
Name:STEVENS, DIANE E (PT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:E
Last Name:STEVENS
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 1:53 ENGEL DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-8366
Mailing Address - Country:US
Mailing Address - Phone:219-464-7382
Mailing Address - Fax:
Practice Address - Street 1:3207 CASCADE DR STE B-C
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-9149
Practice Address - Country:US
Practice Address - Phone:219-465-5460
Practice Address - Fax:219-465-5470
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001122A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics