MEDICARE: DR. DIANE RENEE OTNESS DPT

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
1	225100000X	Physical Therapist	1199716	TX

General Provider Information

NPI Number	:	1487924387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE RENEE OTNESS DPT

Provider Business Mailing Address
First Line	:	12413 JUDSON RD STE 260
Second Line	:
City	:	LIVE OAK
State	:	TX
Zip	:	78233-3262
Country	:	US
Telephone Number	:	210-201-0185
Fax Number	:	210-688-9228

Provider Business Practice Location Address
First Line	:	6511 W LOOP 1604 N STE 117
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-5440
Country	:	US
Telephone Number	:	210-201-0185
Fax Number	:	210-688-9228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	05/08/2025

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