Provider Demographics
NPI:1942259213
Name:DIANDRETH, JAMIE P (PT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:P
Last Name:DIANDRETH
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 1:4536 ROUTE 136
Mailing Address - Street 2:SUITE 12
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6414
Mailing Address - Country:US
Mailing Address - Phone:724-830-8815
Mailing Address - Fax:724-830-8813
Practice Address - Street 1:4536 ROUTE 136
Practice Address - Street 2:SUITE 12
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6414
Practice Address - Country:US
Practice Address - Phone:724-830-8815
Practice Address - Fax:724-830-8813
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006738L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA466231Medicare ID - Type Unspecified