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Individual

KIRK LEWIS DEITRICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
215 N STATE COLLEGE BLVD STE G, ANAHEIM, CA 92806-2932
(714) 999-6596
Mailing address
4938 OAK TREE CT, YORBA LINDA, CA 92886-2549
(702) 461-2591

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
48943
CA
225200000X
Physical Therapy Assistant

Other

Enumeration date
10/18/2017
Last updated
10/18/2017
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