Provider Demographics
NPI:1043670318
Name:DIAZ, AMY (DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BANERJEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8799 NORTH LOOP E STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-1241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8799 NORTH LOOP E STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1241
Practice Address - Country:US
Practice Address - Phone:732-742-3210
Practice Address - Fax:713-674-5169
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1270203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist