Individual
KIMBERLY SLADE DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10183 14TH ST N APT 105, ST PETERSBURG, FL 33716-4323
(361) 947-0940
Mailing address
10183 14TH ST N APT 105, ST PETERSBURG, FL 33716-4323
(361) 947-0940
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
FL
Other
Enumeration date
06/14/2022
Last updated
06/14/2022
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