Provider Demographics
NPI:1649402579
Name:BITTMAN, DIANE K (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:BITTMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3691 GRAYHAWK DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6324
Mailing Address - Country:US
Mailing Address - Phone:920-267-2076
Mailing Address - Fax:
Practice Address - Street 1:12450 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-5800
Practice Address - Country:US
Practice Address - Phone:847-669-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IL070.023412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist