Provider Demographics
NPI:1346038627
Name:DIEKHOFF, VICTORIA L (LMT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:DIEKHOFF
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1666
Mailing Address - Country:US
Mailing Address - Phone:309-467-5000
Mailing Address - Fax:309-467-5100
Practice Address - Street 1:1932 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1666
Practice Address - Country:US
Practice Address - Phone:309-467-5000
Practice Address - Fax:309-467-5100
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.021990225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty