=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922916386
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASMINE ANGIE DIAZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2026
-----------------------------------------------------
Last Update Date | 08/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1061 HARMON AVE
-----------------------------------------------------
City | FORT STEWART
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31314-5641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-802-0393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 E 9TH ST # 52
-----------------------------------------------------
City | FORT STEWART
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31314-5036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-204-7437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------