Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lane David Dieckow

Individual provider Physical Therapist · NPI 1467690073

Lane David Dieckow is a Physical Therapist in Private Practice in Peoria, Illinois. Qualified in 2008, 18 years ago. Practices with Athletico Ltd, a 2,186-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
18
Licensed in
IL
In the registry since
2009
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Practice location Address checks out

3714 N Prospect Rd
Peoria, IL 61614-7743
Phone: (309) 550-7888
Fax: (309) 550-7848
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 070016884 (IL)

Record details

NPI number1467690073
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 4, 2009
Last updated in NPPESJune 28, 2017
Mailing address625 Enterprise Dr, Oak Brook, IL 60523

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Athletico Ltd — 2186 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations11 on file with Medicare

Other providers in Peoria