Provider Demographics
NPI:1841353562
Name:MUNGER, DIANA LOOMIS (PT)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LOOMIS
Last Name:MUNGER
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 1:2675 W ST RTE 89A # 1044
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5240
Mailing Address - Country:US
Mailing Address - Phone:928-275-4175
Mailing Address - Fax:
Practice Address - Street 1:337 N LOY LN
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-9744
Practice Address - Country:US
Practice Address - Phone:928-275-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ81602Medicare ID - Type Unspecified