Individual
MELINDA SUE DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, AT, ATC
Contact information
Practice address
14717 HAMPDEN ST, TAYLOR, MI 48180-6101
(734) 664-0077
Mailing address
14717 HAMPDEN ST, TAYLOR, MI 48180-6101
(734) 664-0077
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
893614894
BLUE CROSS BLUE SHIELD
MI
Enumeration date
12/04/2019
Last updated
04/04/2022
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