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

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