MEDICARE: TINA DIAZ PT

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	PT30381	FL

General Provider Information

NPI Number	:	1619429123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA DIAZ PT

Provider Business Mailing Address
First Line	:	PO BOX 441146
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30160-9522
Country	:	US
Telephone Number	:	678-459-3745
Fax Number	:

Provider Business Practice Location Address
First Line	:	8199 NAVARRE PKWY STE 12A
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-6941
Country	:	US
Telephone Number	:	850-939-1233
Fax Number	:

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

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	01/29/2026

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Directions to “ TINA DIAZ PT” Practice Location

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