MEDICARE: MR. NEIL DIOLA RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 8512	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154354355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NEIL DIOLA RPT

Provider Business Mailing Address
First Line	:	4923 AUGUSTA AVE
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-6332
Country	:	US
Telephone Number	:	727-688-1065
Fax Number	:	727-362-0084

Provider Business Practice Location Address
First Line	:	7500 4TH ST N STE A
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-5410
Country	:	US
Telephone Number	:	727-688-1065
Fax Number	:	727-362-0084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/09/2007

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