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General NPI Number Information
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NPI Number | 1326682253
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Entity Type | Individual
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Provider Name | NYAH DIANE REAM PT
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Gender | Female
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 1800 HARRISON ST
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City | TITUSVILLE
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State | FL
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Zip | 32780-4695
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Country | US
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Telephone | 324-383-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 311 KNOT HOLE CIR
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City | CHULUOTA
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State | FL
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Zip | 32766-6040
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Country | US
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Telephone | 407-451-1684
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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 | PT23079
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License Number State | FL
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