Diane M Imhoff, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1014 Issued in WI

Practice address

700 West Ave S
La Crosse, WI 54601-4783

Phone

(608) 392-9768

Fax

(608) 392-7124

NPI assigned

Feb 24, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Diane M Kies Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331078400000",
    "number": "1043517238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 WEST AVENUE S.",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546014783",
            "telephone_number": "608-392-9768",
            "fax_number": "608-392-7124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WEST AVE S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546014783",
            "telephone_number": "608-392-9768",
            "fax_number": "608-392-7124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMHOFF",
        "first_name": "DIANE",
        "middle_name": "M",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-24",
        "last_updated": "2012-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "1014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "KIES",
            "middle_name": "M",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Leah Ingle, RD

• Physical Therapy Assistant in La Crosse, WI
• Providers in La Crosse, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.