Provider Demographics
NPI:1811149917
Name:MARSEGLIA, DIANA KAY (PT, DPT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:KAY
Last Name:MARSEGLIA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3465 BOX HILL CORPORATE CENTER DR
Practice Address - Street 2:SUITE G
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1261
Practice Address - Country:US
Practice Address - Phone:410-569-4806
Practice Address - Fax:410-569-5474
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3553745000OtherIBC AMERIHEALTH
5070-0108OtherGHMSI
88760514OtherCARE FIRST BC MD
5070-0108OtherGHMSI