Provider Demographics
NPI:1730444357
Name:CHITWOOD, DIANE (PTA)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:CHITWOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8477 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5028
Mailing Address - Country:US
Mailing Address - Phone:352-382-7214
Mailing Address - Fax:352-382-7781
Practice Address - Street 1:1537 NE CEDAR ST
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4808
Practice Address - Country:US
Practice Address - Phone:772-208-5071
Practice Address - Fax:772-261-2108
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA29468225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant