Individual
RYAN DIEDERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2827 NORTHGATE BLVD, FORT WAYNE, IN 46835-2900
(260) 490-1400
Mailing address
302 UNION STATION DR, FORT WAYNE, IN 46814-8964
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004770A
IN
Other
Enumeration date
04/30/2014
Last updated
04/30/2014
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