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General NPI Number Information
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NPI Number | 1417163841
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Entity Type | Individual
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Provider Name | DIANE CHRISTINE SENIOR PT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 36485 INLAND VALLEY DRIVE
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City | WILDOMAR
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State | CA
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Zip | 92595
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Country | US
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Telephone | 951-696-2604
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Fax | 951-677-9788
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Provider Business Mailing Address
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Address Line | 29830 CORTE CRUZADA
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City | MENIFEE
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State | CA
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Zip | 92584
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Country | US
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Telephone | 951-672-0649
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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 | PT19576
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License Number State | CA
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