Individual
MS. ANNETTE LYNN DIEKMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3625 MAGNOLIA AVE, SAINT LOUIS, MO 63110-4048
(314) 771-2990
Mailing address
3011 CHESTNUT ST, CUBA, MO 65453-2004
(573) 205-4817
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2010041501
MO
Other
Enumeration date
05/31/2012
Last updated
05/31/2012
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