Individual
MRS. DAWN MARIE AGNESE DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
137 FOSTER RD, LAKE RONKONKOMA, NY 11779-4310
(631) 588-0104
Mailing address
137 FOSTER RD, LAKE RONKONKOMA, NY 11779-4310
(631) 588-0104
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
020827
NY
Other
Enumeration date
05/31/2007
Last updated
07/08/2007
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