Provider Demographics
NPI:1487868691
Name:HATTERMAN, DIANE LOUISE (PTA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LOUISE
Last Name:HATTERMAN
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 1:1909 ALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-4810
Mailing Address - Country:US
Mailing Address - Phone:308-991-5654
Mailing Address - Fax:
Practice Address - Street 1:1909 ALDEN AVE
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-4810
Practice Address - Country:US
Practice Address - Phone:308-991-5654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1401716225200000X
NE367225200000X
ID2906225200000X
IA001176225200000X
WA60227106225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant