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General NPI Number Information
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NPI Number | 1043331507
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Entity Type | Individual
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Provider Name | LYNDA SUSAN DIANGELO P.T.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 871 RIDGEWAY LOOP RD STE 100
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City | MEMPHIS
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State | TN
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Zip | 38120-4026
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Country | US
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Telephone | 901-759-1282
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Fax | 901-759-1290
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Provider Business Mailing Address
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Address Line | 871 RIDGEWAY LOOP RD
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City | MEMPHIS
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State | TN
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Zip | 38120-4038
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Country | US
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Telephone | 901-759-1282
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Fax | 901-759-1290
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3462
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License Number State | TN
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