Active NPI
Kevin David Diana, PTA
- Physical Therapy Assistant
- Orange City, FL
National Provider Identifier
1093201097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 17272
- Practice address
- 2884 Wellness Ave
Orange City, FL 32763-8426 - Phone
- (386) 774-4404
- Fax
- (386) 774-4496
- NPI assigned
- Jul 3, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 17272 | FL | Primary |
Addresses
Primary practice location
2884 Wellness Ave
Orange City, FL 32763-8426
Mailing address
120 Willowbay Ridge St
Sanford, FL 32771-7990
Phone (321) 662-1174
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17272 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530576000000",
"number": "1093201097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 WILLOWBAY RIDGE ST",
"city": "SANFORD",
"state": "FL",
"postal_code": "327717990",
"telephone_number": "321-662-1174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2884 WELLNESS AVE",
"city": "ORANGE CITY",
"state": "FL",
"postal_code": "327638426",
"telephone_number": "386-774-4404",
"fax_number": "386-774-4496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIANA",
"first_name": "KEVIN",
"middle_name": "DAVID",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-03",
"last_updated": "2018-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "17272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.