Provider Demographics
NPI:1942411574
Name:TALLEY, DIANA MELISSA (DPT)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MELISSA
Last Name:TALLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 ELLESMERE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7938
Mailing Address - Country:US
Mailing Address - Phone:732-421-8638
Mailing Address - Fax:
Practice Address - Street 1:380 DEMOTT LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2762
Practice Address - Country:US
Practice Address - Phone:732-873-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA009831225100000X
NCP12693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist