Provider Demographics
NPI:1659841898
Name:DIETRICH, KIMBERLY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15500 19 MILE RD STE 330
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6313
Mailing Address - Country:US
Mailing Address - Phone:586-412-0016
Mailing Address - Fax:586-412-0117
Practice Address - Street 1:15500 19 MILE RD STE 330
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6313
Practice Address - Country:US
Practice Address - Phone:586-412-0016
Practice Address - Fax:586-412-0117
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist