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NPI Code Detail

MEDICARE: MRS. LEILANI DIAZ

MEDICARE: MRS. LEILANI DIAZ
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 Therapist4338TN

General Provider Information

NPI Number : 1518201045
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LEILANI DIAZ
Provider Business Mailing Address
First Line : 25385 MAIN ST
Second Line :
City : ARDMORE
State : TN
Zip : 38449-3155
Country : US
Telephone Number : 931-427-2143
Fax Number :
Provider Business Practice Location Address
First Line : 25385 MAIN ST
Second Line :
City : ARDMORE
State : TN
Zip : 38449-3155
Country : US
Telephone Number : 931-427-2143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2012
Last Update Date : 11/21/2012

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Directions to “ MRS. LEILANI DIAZ ” Practice Location

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