| Doctor Name: | MRS. NICOLE DAWN DIEDRICH |
| NPI Number: | 1750438826 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.T. |
| License Number: | 070013314 |
| Business Practice Address: | 219 Main St Pecatonica, IL - 610639195 |
| Business Phone Number: | 8152392233 |
| Business Fax Number: | 8152399999 |
| Mailing Address: | 205 W Wacker Dr, Suite 1020 CHICAGO |
| State: | IL |
| Postal Code: | 606061216 |
| Phone Number: | 3126400329 |
| Fax Number: | |
| NPI Enumeration Date: | 01/04/2007 |
| NPI Last Update Date: | 02/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 070013314 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |