Individual
MRS. DIANE MARY KILLEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
19047 N 76TH AVE, GLENDALE, AZ 85308-8304
(623) 561-0499
(623) 561-5227
Mailing address
19047 N 76TH AVE, GLENDALE, AZ 85308-8304
(623) 561-0499
(623) 561-5227
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1673
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1673
PHYSICAL THAERAPY LICENSE
AZ
Enumeration date
11/06/2006
Last updated
07/08/2007
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