Provider Demographics
NPI:1730268103
Name:GREENBERG, DIANE K (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 MONKTON ROAD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443
Mailing Address - Country:US
Mailing Address - Phone:802-453-7200
Mailing Address - Fax:802-453-7220
Practice Address - Street 1:167 MONKTON ROAD
Practice Address - Street 2:SUITE 101B
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443
Practice Address - Country:US
Practice Address - Phone:802-453-7200
Practice Address - Fax:802-453-7220
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040002732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist