=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003910134
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANA PATRICIA MCGRATH PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 11/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2435 US HIGHWAY 19 SUITE 100
-----------------------------------------------------
City | HOLIDAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34691-3903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-939-2230
-----------------------------------------------------
Fax | 727-939-2245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 951 BROKEN SOUND PKWY NW SUITE 225
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33487-3507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-241-9300
-----------------------------------------------------
Fax | 561-372-0214
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | PT12669
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------