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NPI Code Detail

MEDICARE: ANDREW DIECKMANN PT, DPT, LAT, ATC

MEDICARE: ANDREW DIECKMANN PT, DPT, LAT, ATC
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
12255A2300XAthletic Trainer2019026347MO
22251X0800XOrthopedic Physical Therapist6231OK

General Provider Information

NPI Number : 1821573478
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW DIECKMANN PT, DPT, LAT, ATC
Provider Business Mailing Address
First Line : 14638 S KAW DR
Second Line :
City : OLATHE
State : KS
Zip : 66062-4867
Country : US
Telephone Number : 913-645-2348
Fax Number :
Provider Business Practice Location Address
First Line : 1700 S BROADWAY ST STE E
Second Line :
City : MOORE
State : OK
Zip : 73160-5302
Country : US
Telephone Number : 405-735-8777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2018
Last Update Date : 08/11/2022

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Directions to “ ANDREW DIECKMANN PT, DPT, LAT, ATC” Practice Location

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