Provider Demographics
NPI:1932322328
Name:DIAZ, YAMARIE (LPTA)
Entity Type:Individual
Prefix:
First Name:YAMARIE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 CONTESSA DR
Mailing Address - Street 2:UNIT 301
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8004
Mailing Address - Country:US
Mailing Address - Phone:407-208-9982
Mailing Address - Fax:
Practice Address - Street 1:355 ALAFAYA WOODS BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7095
Practice Address - Country:US
Practice Address - Phone:407-365-7272
Practice Address - Fax:407-365-7272
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA14687225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant