MEDICARE: KATHERINE DIETZEL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT010762	GA

General Provider Information

NPI Number	:	1598398901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DIETZEL DPT

Provider Business Mailing Address
First Line	:	800 CRESCENT CENTRE DR STE 300
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7285
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 DALLAS HWY SW STE 520
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2664
Country	:	US
Telephone Number	:	678-383-1696
Fax Number	:	678-681-9106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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Directions to “ KATHERINE DIETZEL DPT” Practice Location

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