Individual
KASSIDY DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
432 E MAIN ST, MIDDLETOWN, DE 19709-1462
(919) 258-2714
(410) 648-4878
Mailing address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 258-2714
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
PT026076
PA
225100000X
Physical Therapist
Primary
J1-0003367
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124401534
—
DE
01
—
3288895
BS BS DE
DE
01
—
AC44-0066
CAREFIRST
DE
Enumeration date
07/02/2015
Last updated
03/21/2022
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