Provider Demographics
NPI:1588801716
Name:DIETZ, ANDREW A (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:A
Last Name:DIETZ
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 1:906 S FEDERAL HWY STE B
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5671
Mailing Address - Country:US
Mailing Address - Phone:561-738-0805
Mailing Address - Fax:561-738-0815
Practice Address - Street 1:906 S FEDERAL HWY STE B
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-5671
Practice Address - Country:US
Practice Address - Phone:561-738-0805
Practice Address - Fax:561-738-0815
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019572225100000X
FLPT25317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist