Provider Demographics
NPI:1043542137
Name:DIEDIKER, HANNAH ELIZABETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:ELIZABETH
Last Name:DIEDIKER
Suffix:
Gender:F
Credentials:PTA
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Mailing Address - Street 1:13336 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1124
Mailing Address - Country:US
Mailing Address - Phone:402-330-2361
Mailing Address - Fax:402-330-5970
Practice Address - Street 1:13336 INDUSTRIAL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1124
Practice Address - Country:US
Practice Address - Phone:402-330-2361
Practice Address - Fax:402-330-5970
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE862225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant