MEDICARE: DIANE RENAE MAYES DPT

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

General Provider Information

NPI Number	:	1730970039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE RENAE MAYES DPT

Provider Business Mailing Address
First Line	:	9125 SHELBY 364
Second Line	:
City	:	HUNNEWELL
State	:	MO
Zip	:	63443-3013
Country	:	US
Telephone Number	:	573-470-3681
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 ROSEWOOD DR
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-2437
Country	:	US
Telephone Number	:	660-785-1834
Fax Number	:

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

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	04/13/2026

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