Provider Demographics
NPI:1578861290
Name:DIESER, REBECCA J (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:DIESER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9743
Mailing Address - Country:US
Mailing Address - Phone:319-351-8440
Mailing Address - Fax:
Practice Address - Street 1:2200 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9743
Practice Address - Country:US
Practice Address - Phone:319-351-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist