Provider Demographics
NPI:1376855015
Name:STIMAC, DIANA THERESE MARQUEZ (PT)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:THERESE MARQUEZ
Last Name:STIMAC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:THERESE
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:32030 23RD AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6031
Practice Address - Country:US
Practice Address - Phone:253-946-4852
Practice Address - Fax:253-946-4862
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-017808225100000X
WAPT 60525569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00852535OtherMEDICARE RR
ILP00931600OtherMEDICARE RAILROAD
ILP00852535OtherMEDICARE RR
ILP00931600OtherMEDICARE RAILROAD
IL214692020Medicare PIN