Provider Demographics
NPI:1912246737
Name:DIANE SIWEK PT INC
Entity Type:Organization
Organization Name:DIANE SIWEK PT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIWEK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-573-5955
Mailing Address - Street 1:5299 PARK PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1462
Mailing Address - Country:US
Mailing Address - Phone:561-573-5955
Mailing Address - Fax:
Practice Address - Street 1:5299 PARK PLACE CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1462
Practice Address - Country:US
Practice Address - Phone:561-573-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0001921171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty