Individual
COURTNIE DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
13138 IL-13, COULTERVILLE, IL 62237-1218
(618) 758-2256
Mailing address
406 N CLINTON ST, NEW ATHENS, IL 62264-1108
(618) 980-5837
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160006900
IL
Other
Enumeration date
09/23/2015
Last updated
12/01/2021
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