Provider Demographics
NPI:1295072577
Name:OLSEN, DIANA MARY GLICINI (PT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARY GLICINI
Last Name:OLSEN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MARY
Other - Last Name:GLICINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:50 CORRINA LN
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:CT
Mailing Address - Zip Code:06420
Mailing Address - Country:US
Mailing Address - Phone:570-574-5913
Mailing Address - Fax:
Practice Address - Street 1:RED ROCK PHYSICAL THERAPY & BALANCE CENTER
Practice Address - Street 2:744 MIDDLETOWN RD
Practice Address - City:CALCHCESTOR
Practice Address - State:CT
Practice Address - Zip Code:06415
Practice Address - Country:US
Practice Address - Phone:860-365-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT014376225100000X
PAPT021128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist