Basic Information
| Provider Information | |||||||||
| NPI: | 1558901454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEARNS | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | LYN | ||||||||
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| Credential: | C,P.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | SELECT REHABILITATION, LLC | ||||||||
| Address2: | 2600 COMPASS ROAD | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777873430 | ||||||||
| FaxNumber: | 8474410734 | ||||||||
| Practice Location | |||||||||
| Address1: | SAMARITAS SENIOR LIVING | ||||||||
| Address2: | 460 PEARL STREET | ||||||||
| City: | CADILLAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317750101 | ||||||||
| FaxNumber: | 2317751390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2020 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 5502002455 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.