Provider Demographics
NPI:1851431233
Name:DIETZ, LEADA (RAC)
Entity Type:Individual
Prefix:MS
First Name:LEADA
Middle Name:
Last Name:DIETZ
Suffix:
Gender:F
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W PHILADELPHIA ST.
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401
Mailing Address - Country:US
Mailing Address - Phone:717-843-2723
Mailing Address - Fax:
Practice Address - Street 1:114 W. PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-5448
Practice Address - Country:US
Practice Address - Phone:717-843-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000225L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist