Provider Demographics
NPI:1780988121
Name:RICH, DIANA (PT)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:RICH
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 1:289 RANDOM RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1407
Mailing Address - Country:US
Mailing Address - Phone:203-855-3564
Mailing Address - Fax:203-852-3418
Practice Address - Street 1:520 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-4034
Practice Address - Country:US
Practice Address - Phone:203-526-0244
Practice Address - Fax:203-852-3418
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist