Basic Information
| Provider Information | |||||||||
| NPI: | 1841268471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER-KATZ | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KATZ | ||||||||
| OtherFirstName: | DIANE | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 8019 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011028000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664314077 | ||||||||
| FaxNumber: | 4137747448 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 MAIN ST | ||||||||
| Address2: | NORTHAMPTON HEALTH CENTER | ||||||||
| City: | FLORENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010621466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135868400 | ||||||||
| FaxNumber: | 4135869286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6242 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 123140 | 01 | MA | FALLON | OTHER | Y66544 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 2329197 | 01 | MA | AETNA US HEALTHCARE | OTHER | 650020187 | 01 | MA | RAILROAD MEDICARE | OTHER | 470247 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 0364789 | 05 | MA | MEDICAID |