Healthcare Provider Details

I. General information

NPI: 1952959009
Provider Name (Legal Business Name): DIANA SHAMROSKI DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA NICOLE DE LA OSSA DPT, ATC

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD STE A115
MARIETTA GA
30068-2110
US

IV. Provider business mailing address

PO BOX 949
ROME GA
30162-0949
US

V. Phone/Fax

Practice location:
  • Phone: 770-321-4720
  • Fax: 770-579-7060
Mailing address:
  • Phone: 770-321-4720
  • Fax: 770-579-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT43505
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018466
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL5989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: