Individual
LISA DIEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
10 HIGH ST, WAKEFIELD, RI 02879-3144
(401) 783-8077
(401) 789-6029
Mailing address
455 TOLL GATE RD, WARWICK, RI 02886-2759
(401) 789-2845
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1309
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11440422
CAQH
RI
01
—
412405
RI BLUE CHIP
RI
Enumeration date
07/16/2006
Last updated
03/29/2019
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