Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA0000005109 | TN |
NPI | 1003485871 |
---|---|
Provider Name | Michele Lynn Dietz |
First Address | Greeneville, TN 37743-6617 |
Second Address | Greeneville, TN 37743-6617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2021 |
Last Update Date | 24/06/2021 |