1043236268 NPI number — MS. DIANE LOUISE DAMIANO PHD PT

Table of content: MS. DIANE LOUISE DAMIANO PHD PT (NPI 1043236268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043236268 NPI number — MS. DIANE LOUISE DAMIANO PHD PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAMIANO
Provider First Name:
DIANE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHD PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043236268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7425 FORSYTH BLVD
Provider Second Line Business Mailing Address:
C B 8221
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63105-2171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-362-7327
Provider Business Mailing Address Fax Number:
314-747-0917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4921 PARKVIEW PL
Provider Second Line Business Practice Location Address:
STE 8A
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110-1032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-362-7327
Provider Business Practice Location Address Fax Number:
314-747-0917
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2002003276 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com