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General NPI Number Information
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NPI Number | 1104755420
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Entity Type | Individual
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Provider Name | DIANA ROSE SYMENS
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Gender | Female
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Dates
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Enumeration Date | 05/14/2026
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 16210 ABERDEEN ST NE
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City | HAM LAKE
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State | MN
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Zip | 55304-5410
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Country | US
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Telephone | 763-413-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 116 RICKARD RD NE
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City | FRIDLEY
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State | MN
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Zip | 55432-3019
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Country | US
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Telephone |
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Fax |
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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 | 11899
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License Number State | MN
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