Healthcare Provider Details

I. General information

NPI: 1205802139
Provider Name (Legal Business Name): DIANNE DENISE DOYLE RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 17TH AVE E STE 101
ALEXANDRIA MN
56308-3734
US

IV. Provider business mailing address

111 17TH AVE E STE 101
ALEXANDRIA MN
56308-3734
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-1144
  • Fax: 320-762-1935
Mailing address:
  • Phone: 320-762-1144
  • Fax: 320-762-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4549
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: