Provider Demographics
NPI:1902078579
Name:DIAMOND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:DIAMOND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESTELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RECREO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-860-5382
Mailing Address - Street 1:402 S PROSPECTORS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1618
Mailing Address - Country:US
Mailing Address - Phone:909-860-5382
Mailing Address - Fax:909-860-5384
Practice Address - Street 1:402 S PROSPECTORS RD
Practice Address - Street 2:SUITE E
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1618
Practice Address - Country:US
Practice Address - Phone:909-860-5382
Practice Address - Fax:909-860-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation