Provider Demographics
NPI:1023128386
Name:NEWQUIST, DIANE (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:NEWQUIST
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 1:766 BUTTERNUT LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2586
Mailing Address - Country:US
Mailing Address - Phone:847-987-1627
Mailing Address - Fax:
Practice Address - Street 1:1213 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-2741
Practice Address - Country:US
Practice Address - Phone:224-505-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623066OtherBCBS PROVIDER #
IL367885100OtherU S DEPT OF LABOR PROV#
IL568080OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP NUMBER
IL650022978OtherR R MEDICARE PIN #
ILP00221605OtherR R MEDICARE PIN #
ILCJ4383OtherR R MEDICARE GROUP #
ILCJ8115OtherR R MEDICARE GRP #
IL568150OtherMEDICARE GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP NUMBER
IL650022978OtherR R MEDICARE PIN #
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILL92997Medicare PIN