Provider Demographics
NPI:1932382876
Name:KLAR, DIANA (DPT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:KLAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:EISENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8 ISLAND HILL AVE
Mailing Address - Street 2:APT. 109
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2643
Mailing Address - Country:US
Mailing Address - Phone:781-480-3151
Mailing Address - Fax:
Practice Address - Street 1:30 WARREN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3602
Practice Address - Country:US
Practice Address - Phone:617-254-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist