Individual
MARIE DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3703 W LAKE AVE, SUITE 200, GLENVIEW, IL 60026-1223
(971) 206-5140
Mailing address
4560 SE INTERNATIONAL WAY, STE 100, MILWAUKIE, OR 97222
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160006085
IL
Other
Enumeration date
06/24/2013
Last updated
03/23/2017
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