Jackson Ray Diede, MAT, ATC
NPI #1760054373 in Sioux Falls, South Dakota
Provider Information
- NPI Number
- 1760054373
- Entity Type
- Individual
- Name
- Jackson Ray Diede, MAT, ATC
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Physical Medicine & Rehabilitation - Sports Medicine
- Credential
- MAT, ATC
- Enumeration Date
- Jul 13, 2021
- Last Updated
- Jul 13, 2021
Practice Location
- Address
- 810 E 23RD ST
- City
- Sioux Falls
- State
- South Dakota
- ZIP Code
- 57105-2135
- Phone
- (605) 331-5890
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physical Medicine & Rehabilitation - Sports Medicine — Sports Medicine |
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