Provider Demographics
NPI:1205879418
Name:GALVIN, DIANE W (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:W
Last Name:GALVIN
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 1:10250 BRIGHTON CIR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2693
Mailing Address - Country:US
Mailing Address - Phone:330-963-7167
Mailing Address - Fax:
Practice Address - Street 1:27600 CHAGRIN BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4439
Practice Address - Country:US
Practice Address - Phone:216-464-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4034902Medicare PIN
OH4034901Medicare PIN