Provider Demographics
NPI:1487921946
Name:STECKLEIN, DIANNE MARIE (PT)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:MARIE
Last Name:STECKLEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16778 CORDILLERA DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-7016
Mailing Address - Country:US
Mailing Address - Phone:563-542-6631
Mailing Address - Fax:563-557-7007
Practice Address - Street 1:16778 CORDILLERA DRIVE
Practice Address - Street 2:
Practice Address - City:PEOSTA
Practice Address - State:IA
Practice Address - Zip Code:52068-7016
Practice Address - Country:US
Practice Address - Phone:563-542-6631
Practice Address - Fax:563-557-7007
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02077225100000X
WI10412-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist