Adam Nelson

 
 06 Dec 2014 19:59:15 EDT 
 To: 19549226864 
 Page: 02/631
 From: Lauris Rigdon 
 Plan of Care 
 Patient: 
 Richard Diaz
 ONONDAGA 
 DOB: 
 26 Jun 1994 Sex: F 
 PHYSICAL THERAPY 
 Visit: 
 24 Jun 2015 Visit # 1 
 Provider: 
 Maria Stalder, PT, DPT 
 NPI# 
 1992425722 
 Clinic Details 
 Case Details 
 Clinic 
 Address 
 Injury Description 
 Date of Plan of Care 
 Onondaga Physical Therapy 
 15 East Genesee Street 
 SIJ dysfunction 
 6/7/2023 
 Suite 130 
 Injury Onset Date 
 3156355xxx 
 M99.04, M25.551 
 07 Oct 2014
 Fax # 
 Referring Physician 
 3153153631 
 MICHAEL MINCOLLA 
 Assessment 
 Patient: Richard Diaz (DOB: 26 Jun 1994) 
 Treated by Maria Stalder, PT. DPT (License #049147) 
 DOS: 11 Apr 2023
 Page 1 of 31 of Plan of Care
