Provider Demographics
NPI:1750540761
Name:PILCH, DIANE SMITH (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:SMITH
Last Name:PILCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:RUTH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:729 CEDAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1508
Mailing Address - Country:US
Mailing Address - Phone:215-643-3590
Mailing Address - Fax:215-643-3590
Practice Address - Street 1:729 CEDAR HILL RD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-1508
Practice Address - Country:US
Practice Address - Phone:215-643-3590
Practice Address - Fax:215-643-3590
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001536E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist