=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528282118
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANNE LOUISE LEONE M.S.P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2375B NEW YORK AVE
-----------------------------------------------------
City | HUNTINGTON STATION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11746-4258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-673-2933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 GRANT ST
-----------------------------------------------------
City | CENTERPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11721-1247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-385-8015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 011954-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------