Provider Demographics
NPI:1013031251
Name:DIENNO, BETH (PTA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:DIENNO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033-2407
Mailing Address - Country:US
Mailing Address - Phone:484-557-7084
Mailing Address - Fax:
Practice Address - Street 1:411 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-4422
Practice Address - Country:US
Practice Address - Phone:610-565-8717
Practice Address - Fax:610-891-0642
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE002121L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant