Provider Demographics
NPI:1770605099
Name:BROWN, DIANE LOUENE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LOUENE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12920 WILKINS RUN RD NE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-8704
Mailing Address - Country:US
Mailing Address - Phone:740-763-2527
Mailing Address - Fax:
Practice Address - Street 1:551 YMCA PL
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6851
Practice Address - Country:US
Practice Address - Phone:614-293-7600
Practice Address - Fax:614-293-7540
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3041225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant