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General NPI Number Information
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NPI Number | 1881811891
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Entity Type | Individual
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Provider Name | NIKI L DIEHL PT
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 2147 PROFESSIONAL DR
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City | GAYLORD
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State | MI
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Zip | 49735-0003
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Country | US
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Telephone | 989-732-0001
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Fax | 989-732-7082
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Provider Business Mailing Address
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Address Line | 1691 COASTER RD
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City | LAKE CITY
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State | MI
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Zip | 49651-8751
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Country | US
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Telephone | 231-269-3500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501011213
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License Number State | MI
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