MEDICARE: DIAMOND STAFFING SOLUTIONS LLC

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	PT2146	OK
2	225100000X	Physical Therapist	PT2179	OK

General Provider Information

NPI Number	:	1508070756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAMOND STAFFING SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	226 NE 14TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-1206
Country	:	US
Telephone Number	:	405-740-7784
Fax Number	:	405-319-9374

Provider Business Practice Location Address
First Line	:	702 NE 37TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-7210
Country	:	US
Telephone Number	:	405-525-3024
Fax Number	:	405-525-3027

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	MARCLAND LESLEY LUSTER
Credential	:	P.T.
Telephone Number	:	405-740-7784

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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