Healthcare Provider Details

I. General information

NPI: 1194873968
Provider Name (Legal Business Name): DIANE LYN DALLAP-PHILLIPS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE LYN DALLAP

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 KEY HWY STE 300
BALTIMORE MD
21230-5550
US

IV. Provider business mailing address

6410 ROCKLEDGE DR NRH REGIONAL REHAB - SUITE 600
BETHESDA MD
20817-1809
US

V. Phone/Fax

Practice location:
  • Phone: 410-230-7830
  • Fax: 410-230-7831
Mailing address:
  • Phone: 301-581-8054
  • Fax: 301-564-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number19046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: