Individual
JEFF L DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
7351 PRAIRIE FALCON RD, 100, LAS VEGAS, NV 89128-0820
(702) 968-0520
(702) 968-0521
Mailing address
7351 PRAIRIE FALCON RD, 100, LAS VEGAS, NV 89128-0820
(702) 968-0520
(702) 968-0521
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0911
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3402185
—
NV
Enumeration date
04/19/2006
Last updated
09/04/2020
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