Individual
AUSTIN E DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
133 N RIVER ST, WILKES BARRE, PA 18711-0800
(570) 208-5900
Mailing address
204 N BROAD MOUNTAIN AVE, FRACKVILLE, PA 17931-1405
(570) 789-2114
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/28/2019
Last updated
08/28/2019
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