Healthcare Provider Details

I. General information

NPI: 1285571356
Provider Name (Legal Business Name): DIANA YUNKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ALBER ST
WABASH IN
46992-1015
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-569-5480
  • Fax: 260-569-5485
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05015531A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: