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General NPI Number Information
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NPI Number | 1932238615
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Entity Type | Individual
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Provider Name | DIANNE SUE TALBOT PT
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 111 WEST THIRD ST.
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City | BROOKSTON
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State | IN
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Zip | 47923-0404
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Country | US
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Telephone | 765-563-6868
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 404 111 WEST THIRD ST
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City | BROOKSTON
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State | IN
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Zip | 47923-0404
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Country | US
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Telephone |
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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 | 05000581A
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License Number State | IN
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