Individual
MRS. DIANNE MARIE FONG REYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BACHELORS DEGREE
Contact information
Practice address
1717 S MAIN ST, MILPITAS, CA 95035-6756
(409) 957-5700
Mailing address
432 DEMPSEY RD UNIT 135, MILPITAS, CA 95035-5675
(415) 465-0994
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
008915
NY
225200000X
Physical Therapy Assistant
Primary
10427
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10427
PHYSICAL THERAPY BOARD OF CALIFORNIA
CA
Enumeration date
05/19/2014
Last updated
05/19/2014
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