Provider Demographics
NPI:1265609366
Name:LUCA, DIANE M (PTA)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:LUCA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WENTWORTH RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1646
Mailing Address - Country:US
Mailing Address - Phone:781-828-3370
Mailing Address - Fax:
Practice Address - Street 1:150 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2914
Practice Address - Country:US
Practice Address - Phone:781-449-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3481225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant