Provider Demographics
NPI:1255513974
Name:VAZQUEZ, DIANYS (PT)
Entity type:Individual
Prefix:MRS
First Name:DIANYS
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANYS
Other - Middle Name:
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:16 NE 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5901
Mailing Address - Country:US
Mailing Address - Phone:503-257-6909
Mailing Address - Fax:
Practice Address - Street 1:16 NE 85TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5901
Practice Address - Country:US
Practice Address - Phone:503-257-6909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist