Provider Demographics
NPI:1245049774
Name:DIEHL, LANDON (DPT, PT)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:
Last Name:DIEHL
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 EBCO CIR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-7344
Mailing Address - Country:US
Mailing Address - Phone:540-490-0308
Mailing Address - Fax:
Practice Address - Street 1:38 EBCO CIR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-7344
Practice Address - Country:US
Practice Address - Phone:540-490-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216857208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation