Provider Demographics
NPI:1700930104
Name:PUGLIESE, DIANNA (PT)
Entity Type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:
Last Name:PUGLIESE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CENTRE DR STE G
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-4117
Mailing Address - Country:US
Mailing Address - Phone:716-662-2922
Mailing Address - Fax:716-662-3828
Practice Address - Street 1:531 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1405
Practice Address - Country:US
Practice Address - Phone:716-332-4838
Practice Address - Fax:888-732-3062
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7989-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB7761Medicare UPIN