Provider Demographics
NPI:1780814186
Name:DIELS, JOHN LESLIE (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LESLIE
Last Name:DIELS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 COUNTY ROAD AB
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-9760
Mailing Address - Country:US
Mailing Address - Phone:608-335-8913
Mailing Address - Fax:
Practice Address - Street 1:1810 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5616
Practice Address - Country:US
Practice Address - Phone:262-548-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2139-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist