Provider Demographics
NPI:1720040561
Name:KANAKKANATT, DIANNE MARGARET (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:MARGARET
Last Name:KANAKKANATT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:MARGARET
Other - Last Name:SHINEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-713-1779
Mailing Address - Fax:513-854-9921
Practice Address - Street 1:350 W WILSON BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2591
Practice Address - Country:US
Practice Address - Phone:614-895-8747
Practice Address - Fax:614-895-8810
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014914225100000X
VA2305202544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist