Diane Lisabeth Blagojevich, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT16849 Issued in CA

Practice address

510 N Prospect Ave
Suite 105
Redondo Beach, CA 90277-3028

Phone

(310) 372-4646

Fax

(310) 798-4667

NPI assigned

Apr 26, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1272240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272240000000",
    "number": "1386961779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22029 MARJORIE AVE",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905036938",
            "telephone_number": "310-251-5996",
            "fax_number": "310-540-8237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 N PROSPECT AVE",
            "address_2": "SUITE 105",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773028",
            "telephone_number": "310-372-4646",
            "fax_number": "310-798-4667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAGOJEVICH",
        "first_name": "DIANE",
        "middle_name": "LISABETH",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-26",
        "last_updated": "2010-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT16849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karl Robert Bingemann, D.D.S.
• Jennifer Birner, LMFT
• Adalia Mae Bishopp
• Black and to Dental Corporation
• Susan Joann Blackwell
• Bloom Family Wellness Center, LLC
• Blue Chair Family Therapy
• Blue Chair Foundation
• Blume Behavioral Health LLC
• Blume Family Therapy Center Inc

• Physical Therapist in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2010; 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.