Provider Demographics
NPI:1669957015
Name:CARTWRIGHT, DIANA GAIL
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:GAIL
Last Name:CARTWRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:GAIL
Other - Last Name:HERSCHBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:39 ANASAZI TRAILS LOOP
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-8761
Mailing Address - Country:US
Mailing Address - Phone:505-321-6255
Mailing Address - Fax:
Practice Address - Street 1:904 LAS LOMAS RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2633
Practice Address - Country:US
Practice Address - Phone:505-924-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist