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General NPI Number Information
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NPI Number | 1508802240
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Entity Type | Individual
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Provider Name | ANTHONY JAMES DIAZ DPT
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Gender | Male
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 711 PARK AVE
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City | MEDINA
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State | NY
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Zip | 14103
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Country | US
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Telephone | 585-798-4344
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Fax | 585-798-0439
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Provider Business Mailing Address
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Address Line | 711 PARK AVE
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City | MEDINA
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State | NY
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Zip | 14103
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Country | US
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Telephone | 585-798-4344
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Fax | 585-798-0439
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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 | 020582
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License Number State | NY
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