Provider Demographics
NPI:1740249291
Name:HOLMES, DIANE LYNNE (MPT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNNE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146
Mailing Address - Country:US
Mailing Address - Phone:412-856-0298
Mailing Address - Fax:
Practice Address - Street 1:401 N HIGHLAND AVE
Practice Address - Street 2:VINTAGE/COMMUNITY LIFE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-2926
Practice Address - Country:US
Practice Address - Phone:412-952-1447
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
071453Medicare ID - Type Unspecified