Individual
ANDY DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 W 40TH AVE, PINE BLUFF, AR 71603-6301
(870) 541-7100
Mailing address
2646 STARK AVE, KANSAS CITY, MO 64129-1442
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2018026095
MO
Other
Enumeration date
04/10/2019
Last updated
04/10/2019
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