Provider Demographics
NPI:1891945960
Name:DIETELBACH, PAMELA S (DPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:DIETELBACH
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 1:1397 S CANFIELD NILES RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4084
Mailing Address - Country:US
Mailing Address - Phone:330-953-0129
Mailing Address - Fax:330-953-0650
Practice Address - Street 1:77 W MCKINLEY WAY
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1953
Practice Address - Country:US
Practice Address - Phone:810-636-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT. 012239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
64-97047OtherUNITED HEALTHCARE
OH2960069Medicaid
34-1877311-01OtherBUREAU OF WORKERS COMP
34-1877311-00OtherBUREAU OF WORKERS COMP
OHH263181Medicare PIN