Provider Demographics
NPI:1336540376
Name:DIETZ, EMILY (ATC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DIETZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 COLLEGE ST
Mailing Address - Street 2:BOX 20271
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5254
Mailing Address - Country:US
Mailing Address - Phone:912-358-3357
Mailing Address - Fax:
Practice Address - Street 1:3219 COLLEGE ST
Practice Address - Street 2:BOX 20271
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5254
Practice Address - Country:US
Practice Address - Phone:912-358-3357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0025892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer