Healthcare Provider Details

I. General information

NPI: 1558310615
Provider Name (Legal Business Name): DIANE LOUISE WHITESIDE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 QUARRY LN STE 120
PLEASANTON CA
94566-8444
US

IV. Provider business mailing address

7549 MAY WAY
SAN RAMON CA
94583-3709
US

V. Phone/Fax

Practice location:
  • Phone: 916-396-1721
  • Fax:
Mailing address:
  • Phone: 916-396-1721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT8701
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: