Individual
MRS. JEAN LOUISE DIETRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
407 N 8TH ST, MOUNT HOREB, WI 53572-1872
(608) 437-5511
(608) 437-9603
Mailing address
559 E VIEW RD, VERONA, WI 53593-1503
(608) 845-2621
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3096-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3096-024
PT LICENSE NUMBER
WI
05
—
40357700
—
WI
Enumeration date
05/29/2007
Last updated
06/06/2013
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