Provider Demographics
NPI:1457428401
Name:BLANTON, DIANA EDWARDS (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:EDWARDS
Last Name:BLANTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:EDWARDS
Other - Last Name:GRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 IVIE TRAIL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722
Mailing Address - Country:US
Mailing Address - Phone:828-863-2850
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL DRIVE
Practice Address - Street 2:ST LUKES HOSPITAL
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-6418
Practice Address - Country:US
Practice Address - Phone:828-894-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist