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NPI Code Detail

MEDICARE: MRS. DIANE MICHELLE MUNAFO LPT

MEDICARE: MRS. DIANE MICHELLE MUNAFO LPT
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
12251G0304XGeriatric Physical TherapistPT-00504OH

General Provider Information

NPI Number : 1619211166
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANE MICHELLE MUNAFO LPT
Provider Business Mailing Address
First Line : 7111 S STIVERS RD
Second Line : P.O. BOX 95
City : GERMANTOWN
State : OH
Zip : 45327-8560
Country : US
Telephone Number : 513-646-4073
Fax Number :
Provider Business Practice Location Address
First Line : 101 MILLS PL
Second Line :
City : NEW LEBANON
State : OH
Zip : 45345-1430
Country : US
Telephone Number : 937-687-1311
Fax Number : 937-687-3991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2012
Last Update Date : 11/22/2012

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