Provider Demographics
NPI:1881811891
Name:DIEHL, NIKI L (PT)
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:L
Last Name:DIEHL
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 1:1691 COASTER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-8751
Mailing Address - Country:US
Mailing Address - Phone:231-269-3500
Mailing Address - Fax:
Practice Address - Street 1:2147 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-0003
Practice Address - Country:US
Practice Address - Phone:989-732-0001
Practice Address - Fax:989-732-7082
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist