Provider Demographics
NPI:1922548668
Name:SIMON, DIANA JHAMAE LABRADOR (PTA)
Entity type:Individual
Prefix:
First Name:DIANA JHAMAE
Middle Name:LABRADOR
Last Name:SIMON
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 1:94-099 WAIPAHU ST APT A212
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1712
Mailing Address - Country:US
Mailing Address - Phone:808-600-9147
Mailing Address - Fax:800-942-7053
Practice Address - Street 1:94-216 FARRINGTON HWY BOX202
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-600-9147
Practice Address - Fax:800-942-7053
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPTA-346225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant