Provider Demographics
NPI:1689821878
Name:DIETZ, MEGHAN SLEMENDA (DPT)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:SLEMENDA
Last Name:DIETZ
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 1:1810 POLK ST
Mailing Address - Street 2:#202
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3041
Mailing Address - Country:US
Mailing Address - Phone:484-919-2837
Mailing Address - Fax:
Practice Address - Street 1:1628 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4604
Practice Address - Country:US
Practice Address - Phone:415-935-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36938225100000X
NY0305531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist