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NPI Code Detail

MEDICARE: MRS. DIANE DISTELCAMP P.T.

MEDICARE: MRS. DIANE DISTELCAMP P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5825-1NY

General Provider Information

NPI Number : 1326067851
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANE DISTELCAMP P.T.
Provider Business Mailing Address
First Line : 25 ULSTER AVE
Second Line :
City : SAUGERTIES
State : NY
Zip : 12477-1212
Country : US
Telephone Number : 845-246-3642
Fax Number : 845-246-1612
Provider Business Practice Location Address
First Line : 25 ULSTER AVE
Second Line :
City : SAUGERTIES
State : NY
Zip : 12477-1212
Country : US
Telephone Number : 845-246-3642
Fax Number : 845-246-1612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. DIANE DISTELCAMP P.T.” Practice Location

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