Healthcare Provider Details

I. General information

NPI: 1043767320
Provider Name (Legal Business Name): DIANA LYNN KAISER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2016
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29017 CHARDON RD
WILLOUGHBY HILLS OH
44092-1475
US

IV. Provider business mailing address

29017 CHARDON RD
WILLOUGHBY HILLS OH
44092-1475
US

V. Phone/Fax

Practice location:
  • Phone: 440-516-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: