Provider Demographics
NPI:1013581602
Name:DEIBOLDT, RICHARD LOUIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOUIS
Last Name:DEIBOLDT
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 1:5770 BAUM BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3763
Mailing Address - Country:US
Mailing Address - Phone:412-661-0400
Mailing Address - Fax:
Practice Address - Street 1:5770 BAUM BLVD # 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3763
Practice Address - Country:US
Practice Address - Phone:412-661-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist