Individual
JONNIE DIEDERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1575 ROBB DR, RENO, NV 89523-3746
(775) 827-3777
(775) 827-1013
Mailing address
5200 SUMMIT RIDGE DR, #5321, RENO, NV 89523-9014
(775) 827-3777
(775) 827-1013
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
0013299
CO
225200000X
Physical Therapy Assistant
09039
OR
225200000X
Physical Therapy Assistant
1954-19
WI
225200000X
Physical Therapy Assistant
Primary
A-0728
NV
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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