Individual provider Active NPI

Dianna L McDonald, PTA

  • Physical Therapy Assistant
  • Port Orange, FL
National Provider Identifier
1952832339
Registry record updated Mar 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA27252 Issued in FL
Practice address
4606 Clyde Morris Blvd Ste 1D
Port Orange, FL 32129-7453
Phone
(386) 492-2986
Fax
(386) 492-2987
NPI assigned
Mar 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA27252 FL Primary

Addresses

Primary practice location

4606 Clyde Morris Blvd Ste 1D
Port Orange, FL 32129-7453

Mailing address

442 Nash LN
Port Orange, FL 32127-9524
Phone (618) 567-6350

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

LicenseStateTypeSpecialty
PTA27252FLMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pro-Motion Physical Therapy of Volusia Cty PastSince Oct 1, 2008 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490572800000",
    "number": "1952832339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 NASH LN",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279524",
            "telephone_number": "618-567-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4606 CLYDE MORRIS BLVD STE 1D",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321297453",
            "telephone_number": "386-492-2986",
            "fax_number": "386-492-2987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "DIANNA",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-27",
        "last_updated": "2017-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA27252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2017; 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.