Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06000329A | IN |
NPI | 1003125139 |
---|---|
Provider Name | Mrs. Michele Diane Deitz |
First Address | Washington, IN 47501-7552 |
Second Address | Washington, IN 47501-4507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2010 |
Last Update Date | 07/10/2010 |