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Individual

ANDREW DIECKMANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT, DPT, LAT, ATC

Contact information

Practice address
1700 S BROADWAY ST STE E, MOORE, OK 73160-5302
(405) 735-8777
Mailing address
14638 S KAW DR, OLATHE, KS 66062-4867
(913) 645-2348

Taxonomy

Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
6231
OK
2255A2300X
Athletic Trainer
2019026347
MO

Other

Enumeration date
09/30/2018
Last updated
08/11/2022
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