Basic Information
| Provider Information | |||||||||
| NPI: | 1629265954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPRING | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2275 NE DOCTORS DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977016324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413825500 | ||||||||
| FaxNumber: | 5413895669 | ||||||||
| Practice Location | |||||||||
| Address1: | 2275 NE DOCTORS DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977016324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413825500 | ||||||||
| FaxNumber: | 5413895669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2007 | ||||||||
| LastUpdateDate: | 05/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00010245 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 6465 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 274012 | 05 | OR | MEDICAID |