Provider Demographics
NPI:1144352089
Name:VERMAELEN, DIANE SCOTTI (PTA, ATC, LAT, FIS)
Entity type:Individual
Prefix:
First Name:DIANE SCOTTI
Middle Name:
Last Name:VERMAELEN
Suffix:
Gender:F
Credentials:PTA, ATC, LAT, FIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15476 RYAN AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769
Mailing Address - Country:US
Mailing Address - Phone:225-938-0797
Mailing Address - Fax:
Practice Address - Street 1:4920 PINEHILL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-2368
Practice Address - Country:US
Practice Address - Phone:225-751-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPTA1983225200000X
0000904062255A2300X
LAJ00065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No174400000XOther Service ProvidersSpecialist