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General NPI Number Information
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NPI Number | 1437705266
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Entity Type | Individual
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Provider Name | DIANE LEE SYVERSON
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Gender | Female
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 1650 PHILLIPS RD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5304
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Country | US
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Telephone | 614-596-2607
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Fax |
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Provider Business Mailing Address
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Address Line | 1913 ILLINOIS AVE
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City | BRADENTON
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State | FL
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Zip | 34207
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Country | US
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Telephone | 763-355-8220
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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