Provider Demographics
NPI:1134270697
Name:SELL, DIANE DODD (DPT)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:DODD
Last Name:SELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SASAPEQUAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-7205
Mailing Address - Country:US
Mailing Address - Phone:203-292-6063
Mailing Address - Fax:
Practice Address - Street 1:2060 POST RD STE B
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5743
Practice Address - Country:US
Practice Address - Phone:203-803-8090
Practice Address - Fax:203-286-1806
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080007823OtherBLUE CROSS BLUE SHIELD
CT080007823OtherBLUE CROSS BLUE SHIELD