Provider Demographics
NPI:1003253352
Name:DIETLEIN, RYAN RICHARD (DPT)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RICHARD
Last Name:DIETLEIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 DILTS RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-9475
Mailing Address - Country:US
Mailing Address - Phone:989-875-2266
Mailing Address - Fax:989-875-2225
Practice Address - Street 1:203 DILTS RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-9475
Practice Address - Country:US
Practice Address - Phone:989-875-2266
Practice Address - Fax:989-875-2225
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501016312OtherLICENSE