Individual
MRS. JEAN LOUISE DIETRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
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
Update your record
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