Corey Lynn Dietze, DPT, ATC-LAC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11466 Issued in TN

Practice address

Blanchfield Army Community Hospital
650 Joel Drive
Fort Campbell, KY 42223

Phone

(270) 798-8400

NPI assigned

Mar 21, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Occupational Physical Therapy Associates

  • Physical Medicine & Rehabilitation Physician
  • Colorado Springs, CO
  • NPI 1760502496
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1417073875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLANCHFIELD ARMY COMMUNITY HOSPITAL",
            "address_2": "650 JOEL DRIVE",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "42223",
            "telephone_number": "270-798-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLANCHFIELD ARMY COMMUNITY HOSPITAL",
            "address_2": "650 JOEL DRIVE",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "42223",
            "telephone_number": "270-798-8400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3002 S Academy Blvd",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809163202",
            "country_code": "US",
            "telephone_number": "719-390-7010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIETZE",
        "first_name": "COREY",
        "middle_name": "LYNN",
        "credential": "DPT, ATC-LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "29738",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305207917",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "9739",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "04029",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "UT",
            "license": "11466",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IA",
            "license": "00515",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "4253",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "11466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Despois
• Whitney A Devers
• Mario Di Biase, PSY.D.
• Ramon Diaz, M.D.
• Amanda Marie Diemer
• Earvean Lashawnda Diggs, DSW, LCSW, CFCS
• Ashley Marie Dimeo, DMD
• Julian Macon Dismukes III, DMD
• Suzyn Mary Douglass-Everhard, M.A.
• Thomas Peter Dove, MD

• Physical Therapist in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.