Provider Demographics
NPI:1336268267
Name:DIETZGEN, MAGDALENA MULHALL (PT)
Entity Type:Individual
Prefix:MISS
First Name:MAGDALENA
Middle Name:MULHALL
Last Name:DIETZGEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2918
Mailing Address - Country:US
Mailing Address - Phone:910-763-3522
Mailing Address - Fax:910-763-3521
Practice Address - Street 1:4526 FOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2918
Practice Address - Country:US
Practice Address - Phone:910-763-3522
Practice Address - Fax:910-763-3521
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist