Malou Diaz, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05007064A Issued in IN

Practice address

1738 165TH St Ste a
Hammond, IN 46320-2821

Phone

(219) 844-1782

Fax

(219) 844-1830

NPI assigned

Oct 31, 2012

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

• Maria Lourdes Diaz Bustalino Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: him@marshfieldclinichealthsystem.cernerdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beaver Dam Community Hospitals Inc

  • Clinic/Center
  • Beaver Dam, WI
  • NPI 1972188555

  WI

  Medicare reassignment NPD
• Flambeau Hospital Inc

  • Clinic/Center
  • Park Falls, WI
  • NPI 1194317966

  WI

  Medicare reassignment NPD
• Flambeau Hospital Inc

  • Critical Access Hospital
  • Park Falls, WI
  • NPI 1700963048

  WI

  Medicare reassignment NPD
• Lakeview Medical Center Inc of Rice Lake

  • Clinic/Center
  • Rice Lake, WI
  • NPI 1093201832

  WI

  Medicare reassignment NPD
• Marshfield Clinic Inc

  • Clinic/Center
  • Marshfield, WI
  • NPI 1952347981

  WI

  Medicare reassignment NPD
• MCHS Hospitals Inc

  • Clinic/Center
  • Marshfield, WI
  • NPI 1093221434

  WI

  Medicare reassignment NPD
• MCHS Hospitals Inc

  • Critical Access Hospital
  • Ladysmith, WI
  • NPI 1952890873

  WI

  Medicare reassignment NPD
• Memorial Hospital Inc

  • Critical Access Hospital
  • Neillsville, WI
  • NPI 1346239373

  WI

  Medicare reassignment NPD
• Beaver Dam Community Hospitals Inc

  • Pharmacy
  • Beaver Dam, WI
  • NPI 1295771780
  NPD
• MCHS Hospitals Inc

  • Durable Medical Equipment & Medical Supplies
  • Eau Claire, WI
  • NPI 1558230847
  NPD
• MCHS Hospitals, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Plover, WI
  • NPI 1386249894
  NPD

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

{
    "created_epoch": "1351641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750118400000",
    "number": "1669726543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1738 165TH ST STE A",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "463202821",
            "telephone_number": "219-844-1782",
            "fax_number": "219-844-1830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 Ministry Pkwy",
            "address_purpose": "LOCATION",
            "city": "Weston",
            "state": "WI",
            "postal_code": "544765220",
            "country_code": "US",
            "telephone_number": "715-393-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "MALOU",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-31",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05007064A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "address_1": "3400 Ministry Pkwy",
            "city": "Weston",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544765220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "BUSTALINO",
            "middle_name": "LOURDES DIAZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kenneth Deangelis Jr.
• Carlos Adolfo Dejesus, DPT
• Dental Center of Hammond
• John A Desalvo, DO
• Emanuela Antoneta Devendran
• Ariel Dodrill
• Ariel Dortch
• Himanshu Y Doshi, MD
• Magdy Dous
• Keith Brian Douts Jr., DDS

• All providers in Hammond, IN
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.