Basic Information
| Provider Information | |||||||||
| NPI: | 1003910134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGRATH | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | PATRICIA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 BROKEN SOUND PKWY NW | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612419300 | ||||||||
| FaxNumber: | 5613720214 | ||||||||
| Practice Location | |||||||||
| Address1: | 2435 US HIGHWAY 19 | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HOLIDAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346913903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279392230 | ||||||||
| FaxNumber: | 7279392245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 11/11/2016 | ||||||||
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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 | 174400000X | PT12669 | FL | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | PT12669 | 01 | FL | FLORIDA LICENSE | OTHER |