Provider Demographics
NPI:1023300316
Name:DIEGEL, MAUREEN MICHELLE (PTA)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MICHELLE
Last Name:DIEGEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:MICHELLE
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P O BOX 61140
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1140
Mailing Address - Country:US
Mailing Address - Phone:361-855-1352
Mailing Address - Fax:361-855-1254
Practice Address - Street 1:5633 S. STAPLES ST.
Practice Address - Street 2:SUITE 500
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4646
Practice Address - Country:US
Practice Address - Phone:361-855-1352
Practice Address - Fax:361-855-1254
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2049100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant