Provider Demographics
NPI:1497352694
Name:DIETZIUS, LEILA (DPT)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:DIETZIUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:
Other - Last Name:DARNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:80 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-4431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 LAKE ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4431
Practice Address - Country:US
Practice Address - Phone:603-881-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHCP024102T225100000X
MS6958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist