Provider Demographics
NPI:1982924551
Name:FLEGEL, DIANA ELAINE (DPT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ELAINE
Last Name:FLEGEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2598 TRITT SPRINGS TRCE NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5261
Mailing Address - Country:US
Mailing Address - Phone:770-977-4363
Mailing Address - Fax:
Practice Address - Street 1:2598 TRITT SPRINGS TRCE NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5261
Practice Address - Country:US
Practice Address - Phone:770-977-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist