MEDICARE: AMY DIEHL MSPT

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	PT015673	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1412637	OTHER	PA	PA BS PROVIDER ID
2	2099536000	OTHER	PA	AMERIHEALTH

General Provider Information

NPI Number	:	1902848427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY DIEHL MSPT

Provider Business Mailing Address
First Line	:	1812 MARSH RD
Second Line	:	STORE 505
City	:	WILMINGTON
State	:	DE
Zip	:	19810-4581
Country	:	US
Telephone Number	:	302-793-0432
Fax Number	:	302-793-0400

Provider Business Practice Location Address
First Line	:	9475 ROOSEVELT BLVD
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19114-2212
Country	:	US
Telephone Number	:	215-464-6200
Fax Number	:	215-464-9834

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	03/09/2009

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