Provider Demographics
NPI:1811539125
Name:DIEBOLD, KAITLIN SHEA (DPT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:SHEA
Last Name:DIEBOLD
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 1:146 WEISSER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2762
Mailing Address - Country:US
Mailing Address - Phone:502-759-1559
Mailing Address - Fax:
Practice Address - Street 1:1212 MARKET ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-7986
Practice Address - Country:US
Practice Address - Phone:502-225-9981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist