Healthcare Provider Details

I. General information

NPI: 1558282095
Provider Name (Legal Business Name): DIANA ELLYN HEMKER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA SMITH PTA

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 S US HIGHWAY 131
THREE RIVERS MI
49093-8830
US

IV. Provider business mailing address

1077 LINDLEY RD
BRONSON MI
49028-9330
US

V. Phone/Fax

Practice location:
  • Phone: 269-256-5595
  • Fax:
Mailing address:
  • Phone: 269-256-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502002152
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: