Provider Demographics
NPI:1336347194
Name:PULIDO, DIANNE B (ATC)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:B
Last Name:PULIDO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 COOPER DR # A
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1608
Mailing Address - Country:US
Mailing Address - Phone:609-204-6260
Mailing Address - Fax:
Practice Address - Street 1:565 NUGENTOWN RD
Practice Address - Street 2:
Practice Address - City:TUCKERTON
Practice Address - State:NJ
Practice Address - Zip Code:08087-3909
Practice Address - Country:US
Practice Address - Phone:609-296-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001213002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer