Provider Demographics
NPI:1942383633
Name:DIANA, CYNTHIA ANNE
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANNE
Last Name:DIANA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:DIANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3650 WEST BETHANY HOME ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-1967
Mailing Address - Country:US
Mailing Address - Phone:602-973-6609
Mailing Address - Fax:602-973-0067
Practice Address - Street 1:3650 WEST BETHANY HOME ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-1967
Practice Address - Country:US
Practice Address - Phone:602-973-6609
Practice Address - Fax:602-973-0067
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4523111N00000X
AZ4387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0233390OtherBCBS