Provider Demographics
NPI:1144402967
Name:VERSAW BARNES, DIANE MANNER
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MANNER
Last Name:VERSAW BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 KENDARBREN AVE
Mailing Address - Street 2:INVO HEALTH CARE ASSOC
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929
Mailing Address - Country:US
Mailing Address - Phone:215-489-8760
Mailing Address - Fax:215-489-8766
Practice Address - Street 1:1780 KENDARBREN AVE
Practice Address - Street 2:INVO HEALTH CARE ASSOC
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929
Practice Address - Country:US
Practice Address - Phone:215-489-8760
Practice Address - Fax:215-489-8766
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT00619L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist