MEDICARE: NICOLETTE DIANA

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	225200000X	Physical Therapy Assistant	160.009637	IL

General Provider Information

NPI Number	:	1598639742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLETTE DIANA

Provider Business Mailing Address
First Line	:	110 EUCLID AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-4217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 EUCLID AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-4217
Country	:	US
Telephone Number	:	227-273-5770
Fax Number	:

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

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	10/24/2025

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Directions to “ NICOLETTE DIANA ” Practice Location

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