Provider Demographics
NPI:1912225012
Name:LEGNER, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LEGNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 SAWYER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-3412
Mailing Address - Country:US
Mailing Address - Phone:970-385-3498
Mailing Address - Fax:970-259-2618
Practice Address - Street 1:281 SAWYER DR STE 200
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-3412
Practice Address - Country:US
Practice Address - Phone:970-385-3498
Practice Address - Fax:970-259-2618
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist