Organization
DIAMOND PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME JAMES DERISO MPT (OWNER, PHYSICAL THERAPIST)
(724) 238-9185
Entity
Organization
Contact information
Practice address
1865 RT 30, LIGONIER, PA 15658-1214
(724) 238-9185
Mailing address
1865 ROUTE 30 W, LIGONIER, PA 15658-9239
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016044730006
—
PA
Enumeration date
10/04/2006
Last updated
09/30/2008
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