Individual
KIM DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4027 S BUSINESS DR, SHEBOYGAN, WI 53081-1261
(920) 207-4440
Mailing address
2736 S 11TH ST, SHEBOYGAN, WI 53081-6852
(920) 207-4440
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14101146
WI
Other
Enumeration date
03/29/2019
Last updated
03/29/2019
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