Provider Demographics
NPI:1285262832
Name:DIEDRICH, ANNE N (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:N
Last Name:DIEDRICH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 E EASTLAND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5761
Mailing Address - Country:US
Mailing Address - Phone:520-955-3523
Mailing Address - Fax:
Practice Address - Street 1:111 S LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1036
Practice Address - Country:US
Practice Address - Phone:520-955-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006147225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist