Individual
KAITLIN SHEA DIEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1212 MARKET ST, LA GRANGE, KY 40031-7986
(502) 225-9981
Mailing address
146 WEISSER AVE, LOUISVILLE, KY 40206-2762
(502) 759-1559
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
10/09/2019
Last updated
10/18/2021
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