Healthcare Provider Details

I. General information

NPI: 1013418870
Provider Name (Legal Business Name): DIANE D JANIEC PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NEWPORT AVE
CHRISTIANA PA
17509-1305
US

IV. Provider business mailing address

1518 MEADOWBROOK LN
WEST CHESTER PA
19380-5918
US

V. Phone/Fax

Practice location:
  • Phone: 610-593-6901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE1003359
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: