Healthcare Provider Details

I. General information

NPI: 1730776964
Provider Name (Legal Business Name): DOLLIE JOY WONG DIAZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NORTH AVE
BATTLE CREEK MI
49017-3396
US

IV. Provider business mailing address

586 LIMEWOOD DR APT B
BATTLE CREEK MI
49017-4575
US

V. Phone/Fax

Practice location:
  • Phone: 269-245-8000
  • Fax:
Mailing address:
  • Phone: 773-396-7248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: