Provider Demographics
NPI:1386811685
Name:DIEDERICHS, JANET L (CMT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:DIEDERICHS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1518
Mailing Address - Street 2:
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452
Mailing Address - Country:US
Mailing Address - Phone:720-434-8285
Mailing Address - Fax:
Practice Address - Street 1:ONE OAKWOOD PARK
Practice Address - Street 2:#106
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104
Practice Address - Country:US
Practice Address - Phone:720-434-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist